Medicatiegebruik bij patiënten met ernstige infecties

• Severe infectious diseases result in an increased volume of distribution. Renal function is usually impaired, but can in fact be increased early in the course of the disease.
• In renally cleared drugs with a small therapeutic index a dose reduction should take place or these medications should be temporarily discontinued.
• Renally cleared antibiotics may be subject to subtherapeutic levels of antibiotics, especially early in the course of the disease.
• Diuretics and RAAS inhibitors should usually be interrupted during acute illness; bèta-blockers should be continued. Statins can usually be continued.
• Paracetamol can usually be prescribed. NSAIDs, however, are almost always contra-indicated.
• Patients with chronic use of corticosteroids should receive a stress dose.
• There is no evidence to support discontinuing immunosuppressants.
• Platelet aggregation inhibitors and directly acting oral anticoagulants are continued, whereas coumarins should be monitored vigorously or substituted for low molecular weight heparins.

Conflict of interest and financial support: none declared.