title: Antibiotic dosing for multidrug-resistant pathogen pneumonia.
abstract: OBJECTIVE
  Nosocomial pneumonia caused by multidrug-resistant pathogens is increasing in the ICU, and these infections are negatively associated with patient outcomes. Optimization of antibiotic dosing has been suggested as a key intervention to improve clinical outcomes in patients with nosocomial pneumonia. This review describes the recent pharmacokinetic/pharmacodynamic data relevant to antibiotic dosing for nosocomial pneumonia caused by multidrug-resistant pathogens.
  
  
  RESULTS
  Optimal antibiotic treatment is challenging in critically ill patients with nosocomial pneumonia; most dosing guidelines do not consider the altered physiology and illness severity associated with severe lung infections. Antibiotic dosing can be guided by plasma drug concentrations, which do not reflect the concentrations at the site of infection. The application of aggressive dosing regimens, in accordance to the antibiotic's pharmacokinetic/pharmacodynamic characteristics, may be required to ensure rapid and effective drug exposure in infected lung tissues.
  
  
  CONCLUSIONS
  Conventional antibiotic dosing increases the likelihood of therapeutic failure in critically ill patients with nosocomial pneumonia. Alternative dosing strategies, which exploit the pharmacokinetic/pharmacodynamic properties of an antibiotic, should be strongly considered to ensure optimal antibiotic exposure and better therapeutic outcomes in these patients.
authors.affiliation: aBurns, Trauma and Critical Care Research Centre, The University of Queensland, Brisbane, Australia bSchool of Pharmacy, International Islamic University of Malaysia, Kuantan, Pahang, Malaysia cDepartment of Intensive Care Medicine dPharmacy Department, Royal Brisbane and Women's Hospital eCentre for Translational Antiinfective Pharmacodynamics, The University of Queensland, Brisbane, Australia.
authors.forename: Mohd H
authors.initials: MH
authors.lastname: Abdul-Aziz
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Lipman
authors.forename: Jason A
authors.initials: JA
authors.lastname: Roberts
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000097:blood; D016638:Critical Illness; D003428:Cross Infection / Q000097:blood / Q000188:drug therapy* / Q000382:microbiology; D024901:Drug Resistance, Multiple, Bacterial; D006801:Humans; D018410:Pneumonia, Bacterial / Q000097:blood / Q000188:drug therapy* / Q000382:microbiology
chemical_list: D000900:Anti-Bacterial Agents