Intensive care unit (ICU) patients with end‑organ failure will require specialised machines or extracorporeal therapiesto support the failing organs that would otherwise lead to death. ICU patients with severe acute kidney injury mayrequire renal replacement therapy (RRT) to remove fluid and wastes from the body, and patients with severe cardi‑orespiratory failure will require extracorporeal membrane oxygenation (ECMO) to maintain adequate oxygen deliverywhilst the underlying pathology is evaluated and managed. The presence of ECMO and RRT machines can furtheraugment the existing pharmacokinetic (PK) alterations during critical illness. Significant changes in the apparentvolume of distribution (Vd) and drug clearance (CL) for many important drugs have been reported during ECMO andRRT. Conventional antimicrobial dosing regimens rarely consider the impact of these changes and consequently, areunlikely to achieve effective antimicrobial exposures in critically ill patients receiving ECMO and/or RRT. Therefore, anin‑depth understanding on potential PK changes during ECMO and/or RRT is required to inform antimicrobial dosingstrategies in patients receiving ECMO and/or RRT. In this narrative review, we aim to discuss the potential impact ofECMO and RRT on the PK of antimicrobials and antimicrobial dosing requirements whilst receiving these extracorpor‑eal therapies. The potential benefits of therapeutic drug monitoring (TDM) and dosing software to facilitate antimicro‑bial therapy for critically ill patients receiving ECMO and/or RRT are also reviewed and highlighted.