title: Individualized antibiotic strategies.
abstract: OBJECTIVE
  Infections are common complications in critically ill patients and are frequently treated with antibiotics. Unfortunately, delivery of optimal therapy is complicated because efficacy of antimicrobials is influenced by the timing of treatment initiation, the use of combination therapy, and the optimization of drug dosing.
  
  
  RESULTS
  Early diagnosis of infection is mandatory to provide a rapid and appropriate antibiotic therapy. The presence of less susceptible strains, in particular for hospital-acquired infections, or patients with severe disease, such as the presence of septic shock, may need combination antibiotic therapy. Antibiotic pharmacokinetics, notably volume of distribution and total body clearance, are significantly altered in these critically ill patients and can influence the attainment of adequate circulating levels when standard dosage regimens are administered. Higher dosing should be considered in such patients, although in case of renal impairment and reduced clearance, drug accumulation could also result in some side-effects. Nebulized antibiotics may provide a better clinical response than systemic antibiotics in ventilator-associated pneumonia because of multidrug-resistant pathogens.
  
  
  CONCLUSIONS
  The optimal use of antibiotics in the management of severe infections is an important challenge for ICU physicians. Antimicrobial therapy needs to be individualized according to specific patient characteristics, infecting organisms, and susceptibility patterns.
authors.affiliation: aDepartment of Intensive Care bDepartment of Infectious Diseases, Hôpital Erasme, Université Libre de Bruxelles (ULB), Brussels, Belgium.
authors.forename: Fabio S
authors.initials: FS
authors.lastname: Taccone
authors.forename: Ottavia
authors.initials: O
authors.lastname: Bond
authors.forename: Federica Z
authors.initials: FZ
authors.lastname: Cavicchi
authors.forename: Maya
authors.initials: M
authors.lastname: Hites
mesh_terms: D000280:Administration, Inhalation; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000493:pharmacokinetics / Q000627:therapeutic use*; D016638:Critical Illness; D004359:Drug Therapy, Combination; D006801:Humans; D007362:Intensive Care Units; D009330:Nebulizers and Vaporizers; D053717:Pneumonia, Ventilator-Associated / Q000188:drug therapy* / Q000401:mortality; D012121:Respiration, Artificial / Q000009:adverse effects; D012772:Shock, Septic / Q000188:drug therapy* / Q000401:mortality; D061665:Time-to-Treatment
chemical_list: D000900:Anti-Bacterial Agents