Implications of acute kidney injury on common drugs used in the postoperative period after pediatric cardiac surgery

Class	Dose reduction not required	Dose reduction required
Antimicrobial	Cefoperazone Ceftriaxone Clindamycin Linezolid Tigecycline	Cefepime Ceftazidime Cefotaxime Clarithromycin Daptomycin Imipenem Meropenem Ciprofloxacin Levofloxacin Cefoperazone-Sulbactam Vancomycin Teicoplanina Piperacillin-tazobactam Aminoglycosides Colistin Metronidazoleb
Antifungal	Oral voriconazolec Oral itraconazoled	Fluconazole Amphotericin B
Antivirals		Acyclovir Ganciclovir Valganciclovir
Anticonvulsant		Phenytoine Levetiracetam Phenobarbitone Sodium valproate
Analgesic	Ketamine	Morphine Fentanylf Tramadol NSAIDs
Sedative	Propofolg Dexmedetomidinei	Midazolamh Lorazepam
Proton pump inhibitor	Pantoprazole
H2 antihistaminic		Ranitidine
Cardiac medications	Amiodarone Esmolol	Digoxinj

^aTeicoplanin has better renal profile than vancomycin, ^bDose only modified when creatinine clearance <10 ml/min, ^cIntravenous voriconazole is contraindicated in renal dysfunction because the carrier sulfobutylether B cyclodextrin gets accumulated, ^dIntravenous itraconazole is contraindicated in renal failure, ^eNo oral loading dose in renal dysfunction, ^fFentanyl is the preferred opioid in renal dysfunction asmetabolites are nontoxic, ^gNot recommended for use in pediatric ICU sedation; ^hWhen creatinine clearance <10 ml/min 50% reduction in dose, ⁱNot FDA approved for pediatric ICU sedation; ^jmeasure levels to prevent toxicity. ICU: Intensive Care Unit, NSAIDs: Nonsteroidal anti-inflammatory drugs