On-call scenario 5: Resolution

Last updated: Friday, July 15, 2016

What an on-call pharmacist could advise...

The study that you have found on Embase is very small, but it advises that the dose of ceftriaxone does not need to be adjusted in patients on CVVH. It explains that the drug is cleared more effectively than the protein binding would predict. This is backed up by what you found in the Renal Drug Database.

Therefore you decide to advise the doctor that the patient may be given a second dose of ceftriaxone as per microbiology advice.

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Follow up

The following morning you hand over the patient to the critical care pharmacist and explain your reasoning. Together you decide to explore the possibility of monitoring ceftriaxone levels and to try to track down some of the other papers you picked up on your Embase search. Since ceftriaxone is normally given as a single daily dose and the patient is now prescribed 2 grams twice daily, you discuss the risks and benefits of changing to a 4 gram once daily regime. What do you think these might be and what would you advise?

If this scenario has made you a little concerned about answering a question like this when you're on-call, then why not look through the Renal tutorial to refresh your knowledge?