Aaron J Heffernan1,2, Fekade B Sime2, Fabio S Taccone3, Jason A Roberts2,4,5. 1. School of Medicine, Griffith University, Gold Coast. 2. Centre for Translational Anti-Infective Pharmacodynamics, School of Pharmacy, The University of Queensland, Woolloongabba, Queensland, Australia. 3. Department of Intensive Care, Erasme Hospital, Universite Libre de Bruxelles, Bruxelles, Belgium. 4. Faculty of Medicine, University of Queensland Centre for Clinical Research, The University of Queensland. 5. Department of Intensive Care Medicine and Pharmacy Department, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.
Abstract
PURPOSE OF REVIEW: Optimized antibiotic dosing regimens improve survival rates in critically ill patients. However, dose optimization is challenging because of fluctuating antibiotic pharmacokinetics both between patients and within a single patient. This study reviews the pharmacokinetic changes that occur in critically ill patients, along with the pharmacodynamics and toxicodynamics of antibiotics commonly used for the treatment of Gram-negative bacterial infections to formulate a recommendation for antibiotic dosing at the bedside. RECENT FINDINGS: Recent studies highlight that critically ill patients do not achieve therapeutic antibiotic exposures with standard antibiotic dosing. Although dose increases are required, the method of administration, such as the use of β-lactam antibiotic continuous infusions and nebulized aminoglycoside administration, may improve efficacy and limit toxicity. In addition, the increased availability of therapeutic drug monitoring and antibiotic dosing software allow the formulation of individualized dosing regimens at the bedside. SUMMARY: When prescribing antibiotic doses, the clinician should consider antibiotic pharmacokinetic and pharmacodynamic principles. Before initiating high-dose antibiotic therapy, therapeutic drug monitoring may be considered to assist the clinician to optimize antibiotic treatment and minimize potential toxicity.
PURPOSE OF REVIEW: Optimized antibiotic dosing regimens improve survival rates in critically illpatients. However, dose optimization is challenging because of fluctuating antibiotic pharmacokinetics both between patients and within a single patient. This study reviews the pharmacokinetic changes that occur in critically illpatients, along with the pharmacodynamics and toxicodynamics of antibiotics commonly used for the treatment of Gram-negative bacterial infections to formulate a recommendation for antibiotic dosing at the bedside. RECENT FINDINGS: Recent studies highlight that critically illpatients do not achieve therapeutic antibiotic exposures with standard antibiotic dosing. Although dose increases are required, the method of administration, such as the use of β-lactam antibiotic continuous infusions and nebulized aminoglycoside administration, may improve efficacy and limit toxicity. In addition, the increased availability of therapeutic drug monitoring and antibiotic dosing software allow the formulation of individualized dosing regimens at the bedside. SUMMARY: When prescribing antibiotic doses, the clinician should consider antibiotic pharmacokinetic and pharmacodynamic principles. Before initiating high-dose antibiotic therapy, therapeutic drug monitoring may be considered to assist the clinician to optimize antibiotic treatment and minimize potential toxicity.
Authors: Aaron J Heffernan; Fekade B Sime; Nilesh Kumta; Steven C Wallis; Brett McWhinney; Jacobus Ungerer; Gloria Wong; Gavin M Joynt; Jeffrey Lipman; Jason A Roberts Journal: Antimicrob Agents Chemother Date: 2022-05-16 Impact factor: 5.938
Authors: Ana Alarcia-Lacalle; Helena Barrasa; Javier Maynar; Andrés Canut-Blasco; Carmen Gómez-González; María Ángeles Solinís; Arantxazu Isla; Alicia Rodríguez-Gascón Journal: Pharmaceutics Date: 2021-06-25 Impact factor: 6.321
Authors: A Abdulla; T M J Ewoldt; N G M Hunfeld; A E Muller; W J R Rietdijk; S Polinder; T van Gelder; H Endeman; B C P Koch Journal: BMC Infect Dis Date: 2020-01-17 Impact factor: 3.090