{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T06:50:10Z","timestamp":1791528610741,"version":"4.3.4"},"reference-count":18,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["accpjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pharmacotherapy"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Evidence\u2010based dosing guidance for medications in critically ill patients with acute kidney injury (AKI) and receiving continuous kidney replacement therapy (CKRT) is limited. Freely available large language models (LLMs) can generate confident, human\u2010like outputs. The accuracy and reproducibility of LLMs in providing precision drug dosing recommendations in the setting of AKI and CKRT have not been evaluated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>We sought to characterize literature concordance and internal consistency of LLM\u2010generated dosing recommendations for cefepime and meropenem in patients with AKI and receiving CKRT.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Six investigators queried the freely available versions of six LLMs (ChatGPT, Claude, Google Gemini, Microsoft Copilot, OpenEvidence, and Perplexity) from July to September 2025 using three standardized vignettes asking for dosing recommendations and rationale to meet prespecified pharmacodynamic targets: (i) adult with AKI not on dialysis receiving cefepime, (ii) child receiving CKRT and cefepime, and (iii) toddler receiving high\u2010effluent CKRT and meropenem. To assess inter\u2010iteration consistency, each investigator also prompted one LLM three times for each vignette. Responses were parsed for concordance with recommendations in primary literature. LLM \u201creasoning\u201d was evaluated for use of pharmacokinetic (PK) equations, citation accuracy versus confabulation, acknowledgment of uncertainty, and recommendations for therapeutic drug monitoring (TDM) for efficacy or safety.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>LLM\u2010generated dosing recommendations varied widely. Mean concordance with literature\u2010based recommendations was 63% (range: 28%\u201394%). LLMs produced variable responses to the same user upon multiple iterations, with variance in daily maintenance doses recommended ranging from 0 to 1000%. OpenEvidence universally cited relevant sources, whereas other LLMs leveraged sources inconsistently or confabulated them. Each recommended TDM, though only Claude consistently acknowledged its own uncertainty.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Freely available LLMs produce highly variable and often discordant antibiotic dosing recommendations for patients with AKI and receiving CKRT. Although valuable for hypothesis generation and literature retrieval, LLM outputs should not be used in isolation for drug dosing in critically ill patients with kidney dysfunction.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/phar.70207","type":"journal-article","created":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T07:16:29Z","timestamp":1790838989000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["User Beware: Inaccuracy and Inconsistency of Large Language Models in Providing Precision Dosing Recommendations for Patients With Kidney Impairment\u2014A Case Series"],"prefix":"10.1002","volume":"46","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1218-8293","authenticated-orcid":false,"given":"H. Rhodes","family":"Hambrick","sequence":"first","affiliation":[{"name":"Division of Nephrology Ann &amp; Robert H. Lurie Children's Hospital of Chicago  Chicago Illinois USA"},{"name":"Department of Pediatrics Northwestern University Feinberg School of Medicine  Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3847-4899","authenticated-orcid":false,"given":"Samuel","family":"Dubinsky","sequence":"additional","affiliation":[{"name":"Department of Critical Care Dalhousie University  Halifax Nova Scotia Canada"},{"name":"Department of Pharmacology Dalhousie University  Halifax Nova Scotia Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-1984-6483","authenticated-orcid":false,"given":"Danica","family":"Quickfall","sequence":"additional","affiliation":[{"name":"Department of Critical Care Mayo Clinic  Scottsdale Arizona USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-5319-9052","authenticated-orcid":false,"given":"Shannon","family":"Reinert","sequence":"additional","affiliation":[{"name":"Division of Nephrology and Hypertension Cincinnati Children's Hospital Medical Center  Cincinnati Ohio USA"},{"name":"Division of Translational and Clinical Pharmacology Cincinnati Children's Hospital Medical Center  Cincinnati Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7737-8499","authenticated-orcid":false,"given":"Sonya","family":"Tang Girdwood","sequence":"additional","affiliation":[{"name":"Division of Translational and Clinical Pharmacology Cincinnati Children's Hospital Medical Center  Cincinnati Ohio USA"},{"name":"Division of Hospital Medicine Cincinnati Children's Hospital Medical Center  Cincinnati Ohio USA"},{"name":"Center for Acute Care Nephrology Cincinnati Children's Hospital Medical Center  Cincinnati Ohio USA"},{"name":"Department of Pediatrics University of Cincinnati College of Medicine  Cincinnati Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5269-214X","authenticated-orcid":false,"given":"Gideon","family":"Stitt","sequence":"additional","affiliation":[{"name":"Division of Clinical Pharmacology University of Utah  Salt Lake City Utah USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,1]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.201502\u20100329OC"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jped.2016.04.006"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.xkme.2023.100641"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.2215\/CJN.05630614"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/sdi.12203"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41746\u2010024\u201001344\u2010w"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.76867"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1038\/s43856\u2010024\u201000717\u20102"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bj.2025.100868"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.4212\/cjhp.v63i2.898"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.3390\/app14052074"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1007\/978-3-031-54827-7_1"},{"key":"e_1_2_11_14_1","volume-title":"Human\u2010Centered 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