Beta-lactam dose reductions in critically ill patients with acute kidney injury: a scoping review
Authors' conclusion
Current evidence on beta-lactam dose reduction in critically ill patients with acute kidney injury is limited and of low quality. Delaying reductions may improve clinical outcomes
Study context
- Population
- Critically ill adults with AKI receiving beta-lactams
- Participants
- 1,407 adults · 11 studies
- Comparison
- Beta-lactam dosing strategies
- Outcome
- Pharmacological and clinical outcomes
Methodological detailssystematic, PRISMA-ScR, Quality assessed with ROB-2 and ROBINS-E, Searched Medline, Embase, Web of Science, Cochrane CENTRAL and Google Scholar from inception through March 24, 2025
- Systematic
- PRISMA-ScR
- Quality assessed with ROB-2 and ROBINS-E
- Searched Medline, Embase, Web of Science, Cochrane CENTRAL and Google Scholar from inception through March 24, 2025
Main finding
As reported in the abstract
- Higher beta-lactam plasma concentrations generally in patients with AKI, even with already reduced dosages (7 studies)
- Early dose reductions associated with lower rates of neurotoxicity (1 study)
- Higher rates of treatment failure with early dose reductions (1 study)
- Delayed dose reductions linked to reduced mortality (3 studies)
- Risk of bias high in most studies
- Most studies observational; one RCT
Original publication
Beta-lactam dose reductions in critically ill patients with acute kidney injury: a scoping review. Crit Care. Published 2 December 2025. doi:10.
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