Question 1

Cockcroft-Gault vs CKD-EPI — which should I use for dosing?

Accepted Answer

Cockcroft-Gault remains the standard reference for drug dosing in regulatory labelling and most pharmacokinetic studies. CKD-EPI may overestimate function in older or low-muscle-mass patients, potentially under-adjusting doses. Use Cockcroft-Gault for dose adjustments unless your local formulary explicitly specifies an alternative.

Question 2

Should I hold antibiotics before haemodialysis?

Accepted Answer

It depends on the drug's dialysability. For drugs significantly removed by dialysis (e.g., many beta-lactams, vancomycin), schedule the dose after dialysis to avoid loss. For drugs not dialysed (e.g., ceftriaxone, doxycycline), timing of the dose relative to dialysis is less important. The tool specifies dialysability for each antibiotic.

Question 3

How should I dose antibiotics in augmented renal clearance?

Accepted Answer

Augmented renal clearance (CrCl >130 mL/min) is common in young, critically ill patients without CKD. Standard doses may lead to subtherapeutic concentrations. Consider increased doses (e.g., piperacillin-tazobactam 4.5 g Q6H instead of Q8H) and therapeutic drug monitoring where available.