An open-label, randomized, pragmatic clinical trial comparing the current clinical practices to pharmacologist guided optimization of antimicrobial therapy based on average creatinine-urea clearance in critically ill patients - A Pilot study

Antimicrobial therapy plays essential role in the management of patients admitted in the critical care unit. There is a considerable variation in the hemodynamics of critically ill patients. They may experience acute kidney injury or augmented renal clearance during their course of stay. This hemodynamic instability affects the pharmacokinetics of the administered antimicrobial agents which are primarily exhibit renal elimination. This leads to unstable therapeutic concentration which can result in therapeutic failure or toxicity leading to adverse reactions. Dose adjustment is usually done by calculating estimated glomerular filtration rate (eGFR) which is often unreliable in critically ill patients. Calculating the GFR using average of urine urea and creatinine clearance and optimizing dose according to this is found superior to eGFR in various studies. Our hypothesis is ’What is the effectiveness of Pharmacologist guided optimization of antimicrobial therapy based on average creatinine-urea clearance on clinical outcomes in critically ill patient admitted in critical care unit ?’. Therefore, our aim is to evaluate the effectiveness of average creatinine-urea clearance in optimization of antimicrobial therapy in critically ill patients admitted in Critical care unit.