Augmented renal clearance in critically ill patients: Etiology, definition and implications for beta-lactam dose optimization

Fekade Bruck Sime, Andrew A Udy, Jason A. Roberts

Research output: Contribution to journalArticleOtherpeer-review

100 Citations (Scopus)


The renal clearance of antibiotics may be elevated in some critically ill patients. This paper reviews this recently described phenomenon, referred to as augmented renal clearance (ARC). ARC is considered to be driven by pathophysiological elevation of glomerular filtration, and is defined as a creatinine clearance >130 mL/min/173 m2. This in turn promotes very low antibiotic concentrations. This effect may lead to adverse clinical outcomes, particularly with beta-lactam antibiotics, as they require prolonged exposure for optimal antibacterial activity. The use of extended or continuous infusions is an effective strategy to improve exposure. However, because the effect of ARC is potentially quite variable, regular therapeutic drug monitoring (TDM) may be necessary to ensure all patients achieve effective concentrations.

Original languageEnglish
Number of pages6
JournalCurrent Opinion in Pharmacology
Publication statusPublished - Oct 2015

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