title: Antibiotic dose optimization in critically ill patients.
abstract: The judicious use of existing antibiotics is essential for preserving their activity against infections. In the era of multi-drug resistance, this is of particular importance in clinical areas characterized by high antibiotic use, such as the ICU. Antibiotic dose optimization in critically ill patients requires sound knowledge not only of the altered physiology in serious infections - including severe sepsis, septic shock and ventilator-associated pneumonia - but also of the pathogen-drug exposure relationship (i.e. pharmacokinetic/pharmacodynamic index). An important consideration is the fact that extreme shifts in organ function, such as those seen in hyperdynamic patients or those with multiple organ dysfunction syndrome, can have an impact upon drug exposure, and constant vigilance is required when reviewing antibiotic dosing regimens in the critically ill. The use of continuous renal replacement therapy and extracorporeal membrane oxygenation remain important interventions in these patients; however, both of these treatments can have a profound effect on antibiotic exposure. We suggest placing emphasis on the use of therapeutic drug monitoring and dose individualization when optimizing therapy in these settings.
authors.affiliation: Burns Trauma and Critical Care Research Centre, University of Queensland, Brisbane, Queensland, Australia; Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia; School of Pharmacy, University of Queensland, Brisbane, Queensland, Australia. Electronic address: meninocotta@gmail.com.
authors.forename: M O
authors.initials: MO
authors.lastname: Cotta
authors.affiliation: Burns Trauma and Critical Care Research Centre, University of Queensland, Brisbane, Queensland, Australia; Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; School of Pharmacy, University of Queensland, Brisbane, Queensland, Australia.
authors.forename: J A
authors.initials: JA
authors.lastname: Roberts
authors.affiliation: Burns Trauma and Critical Care Research Centre, University of Queensland, Brisbane, Queensland, Australia; Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.
authors.forename: J
authors.initials: J
authors.lastname: Lipman
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000009:adverse effects / Q000493:pharmacokinetics; D016638:Critical Illness / Q000628:therapy*; D016903:Drug Monitoring; D015199:Extracorporeal Membrane Oxygenation; D006801:Humans; D009102:Multiple Organ Failure / Q000188:drug therapy / Q000503:physiopathology; D009994:Osmolar Concentration; D017582:Renal Replacement Therapy; D018805:Sepsis / Q000188:drug therapy / Q000503:physiopathology; D012772:Shock, Septic / Q000188:drug therapy / Q000503:physiopathology
chemical_list: D000900:Anti-Bacterial Agents
keywords: Antibiotics; Antibióticos; Choque séptico; Critically ill; Críticamente enfermo; Dose optimization; Optimización de la dosis; Sepsis grave; Septic shock; Severe sepsis