ABSTRACT
Aim: To determine the antibiotics requiring dosage adjustment in community-acquired pneumonia patients with renal impairment and to assess in-hospital mortality in the patients requiring dosage adjustment.
Subjects and Methods: A prospective and observational study was carried out in a tertiary care hospital. All community-acquired pneumonia patients with mild to moderate renal impairment were included. The Cockroft-gault formula or MDRD equation was used to calculate creatinine clearance. The mean creatinine clearance values were calculated by t-test and chi-square test was used to test categorical variables. The odds ratio and relative risk were estimated to test the association between antibiotics requiring dosage adjustment and mortality.
Results: Fifty-two of the 136 pneumonia patients were found to have renal impairment. The mean serum creatinine in all patients was 2.4 mg/dL and calculated creatinine clearance was 36.3 ml/min/m2 (SD, 16.45). Approximately 46% of the patients received antibiotics that required dose adjustment with 34% of patients had their antibiotics appropriately adjusted; 12% of patients were required to be adjusted appropriately. The antibiotics requiring dosage adjustment when compared with mortality did not show any significance (P = 0.91) and odds ratio [0.92 (95%CI 0.22 – 3.92)]. The relative risk of patients requiring dosage adjustment was 0.96 (95%CI 0.5 – 1.84).
Conclusion: The proportions of antibiotics requiring the adjustment in Community-acquired pneumonia patients with renal impairment were high in the present study. However, the risk of mortality in the inappropriately adjusted patients was found to be non-significant. Further large randomized studies particularly focusing on in-hospital mortality of the patients with renal impairment is warranted.
Keywords:Community-acquired pneumonia, renal impairment, antibiotics dose adjustment, mortality.