Antibiotics requiring dosage adjustment in community acquired pneumonia patients with renal impairment

Md Aslam Ali Hashmi1, Meer Mudabbir Ali1, MA Iqbal Rasheed1, Syed Fawaz Hussain1, Syed Areefulla Hussainy1, U. Ramchander Rao2, Javed Akhtar Ansari1.
1Department of Pharmacy Practice (PharmD), MESCO College of Pharmacy, Mustaidpura, Hyderabad, INDIA.
2Department of General Medicine, Osmania General Hospital (OGH), Afzal Gunj, Hyderabad, INDIA.

ORIGINAL RESEARCH ARTICLE
Volume 2017, Issue 2017, Article ID 128, Page 01-07.

*Author for correspondence
E-mail: aslam.hashmi03@gmail.com

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.