Halilovic and Heintz developed an algorithm to guide antibiotic dosing in a patient with cirrhosis. The authors are from the University of the Pacific and University of California Sacramento.
Patient selection: cirrhosis
Goal: prescribe a safe and effective antibiotic
Parameters:
(1) availability of a safer and equally effective alternative
(2) data available to guide dosing
(3) risk of concentration-dependent toxicity (hepatotoxicity, etc)
(4) percent of drug bound to protein
Safer Choice
Data Available
Toxicity
Protein Binding
Option
Yes
NA
NA
NA
1
No
Yes
NA
NA
2
No
No
high risk
NA
3
No
No
NA
> 90%
3
No
No
No
<= 90%
4
Option
Execution
1
Use alternative therapy.
2
Use data to guide and to monitor therapy.
3
Use with caution. Consider dose reduction. Assess overal risk to benefit. Look for alternative therapy.
4
Usually no dose adjustment needed. Caution advised.
General guidance:
(1) Clinical judgment warranted.
(2) Monitor clinical course and liver function tests.
(3) Watch for drug-drug interactions.
(4) Manage other conditions that may affect outcome.
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