title: Clinical implications of antibiotic pharmacokinetic principles in the critically ill.
abstract: Successful antibiotic therapy in the critically ill requires sufficient drug concentrations at the site of infection that kill or suppress bacterial growth. The relationship between antibiotic exposure and achieving the above effects is referred to as pharmacokinetics/pharmacodynamics (PK/PD). The associated indices therefore provide logical targets for optimal antibiotic therapy. While dosing regimens to achieve such targets have largely been established from studies in animals and non-critically ill patients, they are often poorly validated in the ICU. Endothelial dysfunction, capillary leak, altered major organ blood flow, deranged plasma protein concentrations, extremes of body habitus, the application of extracorporeal support modalities, and a higher prevalence of intermediate susceptibility, independently, and in combination, significantly confound successful antibiotic treatment in this setting. As such, the prescription of standard doses are likely to result in sub-therapeutic concentrations, which in turn may promote treatment failure or the selection of resistant pathogens. This review article considers these issues in detail, summarizing the key changes in antibiotic PK/PD in the critically ill, and suggesting alternative dosing strategies that may improve antibiotic therapy in these challenging patients.
authors.affiliation: Burns, Trauma, and Critical Care Research Centre, Royal Brisbane and Womens Hospital, The University of Queensland, Herston, QLD, 4029, Australia, andrew_udy@health.qld.gov.au.
authors.forename: Andrew A
authors.initials: AA
authors.lastname: Udy
authors.forename: Jason A
authors.initials: JA
authors.lastname: Roberts
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Lipman
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000493:pharmacokinetics*; D016638:Critical Illness / Q000628:therapy*; D054796:Drug Dosage Calculations; D006801:Humans
chemical_list: D000900:Anti-Bacterial Agents
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