title: The use and risks of antibiotics in critically ill patients.
abstract: BACKGROUND
  The altered pathophysiology in critically ill patients presents a unique challenge in both the diagnosis of infection and the appropriate prescription of antibiotics. In this context, the importance of effective and timely treatment needs to be weighed against the individual and community harms associated with antibiotic collateral damage and antibiotic resistance.
  
  
  METHODS
  We evaluate the principles of antibiotic use in critically ill patients, including dose optimisation, use of combination antibiotic therapy, therapeutic drug monitoring, appropriate antibiotic therapy duration, de-escalation, and utilisation of sepsis biomarkers. We also describe the potential risks associated with antibiotic therapy including antibiotic resistance, delayed treatment, treatment failure, and collateral damage.
  
  
  CONCLUSIONS
  Prescribing teams must be aware of the impact of critical illness on their patients and tailor antibiotic therapy appropriately to prevent the significant harms associated with suboptimal antibiotic administration.
authors.affiliation: a Department of Intensive Care Medicine , Royal Brisbane and Women's Hospital , Brisbane , Australia.|b Burns, Trauma and Critical Care Research Centre, School of Medicine , The University of Queensland , Brisbane , Australia.
authors.forename: Kerina J
authors.initials: KJ
authors.lastname: Denny
authors.affiliation: a Department of Intensive Care Medicine , Royal Brisbane and Women's Hospital , Brisbane , Australia.|c School of Pharmacy , The University of Queensland , Brisbane , Australia.
authors.forename: Menino O
authors.initials: MO
authors.lastname: Cotta
authors.affiliation: b Burns, Trauma and Critical Care Research Centre, School of Medicine , The University of Queensland , Brisbane , Australia.
authors.forename: Suzanne L
authors.initials: SL
authors.lastname: Parker
authors.affiliation: a Department of Intensive Care Medicine , Royal Brisbane and Women's Hospital , Brisbane , Australia.|b Burns, Trauma and Critical Care Research Centre, School of Medicine , The University of Queensland , Brisbane , Australia.|c School of Pharmacy , The University of Queensland , Brisbane , Australia.
authors.forename: Jason A
authors.initials: JA
authors.lastname: Roberts
authors.affiliation: a Department of Intensive Care Medicine , Royal Brisbane and Women's Hospital , Brisbane , Australia.|b Burns, Trauma and Critical Care Research Centre, School of Medicine , The University of Queensland , Brisbane , Australia.|d School of Nursing , Queensland University of Technology , Brisbane , Australia.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Lipman
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000009:adverse effects; D001424:Bacterial Infections / Q000188:drug therapy*; D015415:Biomarkers / Q000378:metabolism; D016638:Critical Illness; D016903:Drug Monitoring / Q000379:methods; D024881:Drug Resistance, Bacterial; D006801:Humans; D018805:Sepsis / Q000188:drug therapy
chemical_list: D000900:Anti-Bacterial Agents; D015415:Biomarkers
keywords: Antibiotics; critical illness; infection; resistance; sepsis