Plazomycin Dosing in Acute Kidney Injury

General Recommendations

• The Kidney Disease: Improving Global Outcomes (KDIGO) guidelines recommend avoiding dose-adjusted plazomycin in AKI unless no less nephrotoxic alternatives exist, and if used, employ single daily dosing with therapeutic drug monitoring after 48 hours 1, 2
• The KDIGO guidelines suggest avoiding aminoglycosides entirely in AKI unless no suitable, less nephrotoxic therapeutic alternatives are available 1, 2
• The nephrotoxic potential of aminoglycosides makes them particularly problematic in patients with existing kidney injury 1

Dosing Strategies

• The American College of Physicians recommends using single daily dosing rather than multiple-dose daily regimens in patients with normal baseline kidney function 1, 2
• The Kidney Disease: Improving Global Outcomes (KDIGO) guidelines recommend monitoring aminoglycoside drug levels when single-daily dosing is used for more than 48 hours 1, 2
• The National Kidney Foundation recommends monitoring drug levels when treatment exceeds 24 hours for multiple daily dosing regimens 1, 2

Renal Function Considerations

• The American Journal of Kidney Diseases recommends temporary discontinuation or dose adjustment of renally excreted drugs in patients with GFR <60 mL/min/1.73 m² who have serious intercurrent illness increasing AKI risk 3
• The American Journal of Kidney Diseases suggests considering methods based on cystatin C or direct GFR measurement rather than creatinine-based estimates when precision is required for drugs with narrow therapeutic ranges 3

Therapeutic Drug Monitoring

• The Kidney Disease: Improving Global Outcomes (KDIGO) guidelines recommend measuring actual drug levels to guide dosing, particularly after 48 hours of therapy 1, 2
• The American Journal of Kidney Diseases recommends not relying on creatinine-based estimates alone for therapeutic drug monitoring 3

Special Populations

• The Clinical Gastroenterology and Hepatology journal recommends withdrawing all potentially nephrotoxic agents and assessing volume status before determining antibiotic dosing in patients with cirrhosis and AKI 5
• The Clinical Gastroenterology and Hepatology journal suggests that patients with cirrhosis and AKI have altered pharmacokinetics and increased risk of hepatorenal syndrome requiring special attention 5