Challenges and Potential Solutions – Individualised Antibiotic Dosing at the Bedside for Critically Ill Patients: a structured review
By J. Roberts, M. Abdul-Aziz, J. Lipman, J. Mouton, A. Vinks, T. Felton, W. Hope, A. Farkas, M. Neely, Jerome J. Schentag and 4 more. Lancet. Infectious Diseases (Print), 2014
862 citations recorded by the source corpus.
Summary Infections in critically ill patients are associated with persistently poor clinical outcomes. These patients have severely altered and variable antibiotic pharmacokinetics and are infected by less susceptible pathogens. Antibiotic dosing that does not account for these features is likely to result in sub-optimal outcomes. In this paper, we review the patient- and pathogen-related challenges that contribute to inadequate antibiotic dosing and discuss how a process for individualised antibiotic therapy, that increases the accuracy of dosing, can be implemented to further optimise care for the critically ill patient. The process for optimised antibiotic dosing firstly requires determination of the physiological derangements in the patient that can alter antibiotic concentrations including altered fluid status, microvascular failure, serum albumin concentrations as well as altered renal and hepatic function. Secondly, knowledge of the susceptibility of the infecting pathogen should be determined through liaison with the microbiology laboratory. The patient and pathogen challenges can then be solved by combining susceptibility data with measured antibiotic concentration data (where possible) into a clinical dosing software. Such software uses pharmacokinetic-pharmacodynamic (PK/PD) models from critically ill patients to accurately predict the dosing requirements for the individual patient with the aim of optimising antibiotic exposure and maximising effectiveness.
Subfields: Applied Microbiology and Biotechnology, Epidemiology, Pharmacology
View Paper: https://www.semanticscholar.org/paper/1faa1a9509b3d1c50e7dadd671ecbc113e0c0029
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In Applied Microbiology and Biotechnology
In Epidemiology
- A. Rhodes
- Laura Evans
- Janice L. Zimmerman
- Mitchell M. Levy
- R. Dellinger
- Mervyn Singer
- Djillali Annane
- P. Nordmann
In Pharmacology
Citations in the corpus
- Burn wound healing and treatment: review and advancements (2015, background): “Bacterial cultures can aid in the selection of an appropriate antibiotic, especially in cases of bacterial drug resistance, but altered pharmacokinetic parameters in burn patients must be considered and dosing should be adjusted accordingly to maximize antibiotic efficacy [79].”
- Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016 (2017, background): “(markedly increasing volume of distribution), variable kidney and hepatic perfusion (affecting drug clearance) and altered drug binding due to reduced serum albumin [159].”
- Polymyxins: Antibacterial Activity, Susceptibility Testing, and Resistance Mechanisms Encoded by Plasmids or Chromosomes (2017, background): “critically ill patients, as they are most at risk for high morbidity and mortality (52).”
- Burn injury: Challenges and advances in burn wound healing, infection, pain and scarring (2018, background): “Physiological changes include altered fluid balance, a hyperdynamic circulation, renal and hepatic dysfunction and organ support [98].”