Using PK/PD to optimize antibiotic dosing for critically ill patients

Current Pharmaceutical Biotechnology
Jason A Roberts

Abstract

Antibiotic prescription for critically ill patients is a complicated process because of the pharmacokinetic differences of this patient population with non-critically ill patients and the lack of robust informative studies. This article seeks to review the available literature describing dosing requirements for optimized treatment of critically ill patients and to discuss a framework to rationally address complex cases by outlining the suggested processes for optimal achievement of pharmacokinetic/ pharmacodynamic targets. A variety of papers exist describing the effect of pathophysiology on antibiotic kinetics. In the critically ill patient, dysfunction of almost any organ system can result in significant changes to drug volume of distribution and clearance. Dysfunction of the cardiovascular and renal systems in particular is problematic and can lead to potentially sub-therapeutic antibiotic concentrations in blood and in interstitial fluid. In response to altered pharmacokinetics, dose regimens that adhere to the pharmacodynamics of the antibiotic are essential. In the absence of validated dosing algorithms, therapeutic drug monitoring data and susceptibility data of the infecting pathogen should be inputted into a Bayesian s...Continue Reading

Associated Clinical Trials

Citations

Nov 15, 2012·Clinical Pharmacokinetics·Jason A RobertsJeffrey Lipman
Sep 18, 2013·International Journal of Antimicrobial Agents·Syamhanin AdnanJason A Roberts
Apr 24, 2012·Clinical and Experimental Pharmacology & Physiology·Mahipal G SinnollareddyJason A Roberts
Jan 13, 2012·Critical Care : the Official Journal of the Critical Care Forum·Matt P WiseAnton G Saayman
May 13, 2014·Intensive Care Medicine·Francesco G De Rosa, Jason A Roberts
Aug 1, 2013·Expert Opinion on Drug Metabolism & Toxicology·M del Mar Fernández de GattaJose M Lanao
Aug 13, 2011·British Journal of Clinical Pharmacology·Jason A RobertsJennifer H Martin
Apr 12, 2016·Cancer Chemotherapy and Pharmacology·Ali Aboel DahabNorman W Smith
Apr 24, 2012·Journal of Critical Care·Kiran ShekarJason A Roberts
Apr 18, 2015·Critical Care : the Official Journal of the Critical Care Forum·Darren M RobertsUNKNOWN RENAL Replacement Therapy Study Investigators
Mar 7, 2018·Antimicrobial Agents and Chemotherapy·Maria Goul AndersenKristina Öbrink-Hansen
Oct 20, 2015·Therapeutic Advances in Drug Safety·Thomas M PolasekMichael J Sorich
Oct 29, 2018·Naunyn-Schmiedeberg's Archives of Pharmacology·Katharina OlbrischWalter Raasch
Jan 4, 2019·Antimicrobial Agents and Chemotherapy·Julien OllivierDominique Breilh
Feb 7, 2012·Drugs·Francisco Álvarez-Lerma, Santiago Grau
Mar 25, 2014·Expert Review of Anti-infective Therapy·Menino Osbert CottaStijn Blot
May 3, 2020·ASAIO Journal : a Peer-reviewed Journal of the American Society for Artificial Internal Organs·Kiran ShekarUNKNOWN ELSO Guideline Working Group*
Feb 4, 2014·The Medical Journal of Australia·Vidya PereraRichard O Day
Jul 1, 2020·ASAIO Journal : a Peer-reviewed Journal of the American Society for Artificial Internal Organs·Kiran ShekarUNKNOWN ELSO Guideline Working Group
Sep 17, 2020·Critical Care : the Official Journal of the Critical Care Forum·Alan AbdullaBirgit C P Koch
Aug 7, 2019·Current Drug Metabolism·Ayse Basak Engin, Atilla Engin
Aug 3, 2020·International Journal of Antimicrobial Agents·A MarsotR Guilhaumou
Sep 18, 2020·International Journal of Antimicrobial Agents·Suzanne L ParkerJason A Roberts
Jul 3, 2021·Microorganisms·Pedro PóvoaLuís Coelho

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