Abstract
Generic dosing—essentially a one-size-fits-all approach—has systematically ignored the important pharmacokinetic changes associated with critical illness, and exposes the patient to suboptimal dosing, potentially resulting in clinical failure of antibiotic therapy and development of antibiotic resistance. Optimized antibiotic dosing refers to the integrated approach where the characteristics of the patient, the drug, and the microorganism are all considered when determining how to adequately treat the infection with minimal side effects. Significant advances have been made and applying this concept to the critically ill patient is now possible, although more research is needed to further individualize antibiotic therapy.
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References
Tabah A, De Waele J, Lipman J, Zahar JR, Cotta MO, Barton G, Timsit JF, Roberts JA, Working Group for Antimicrobial Use in the ICU within the Infection Section of the European Society of Intensive Care Medicine ESICM (2015) The ADMIN-ICU survey: a survey on antimicrobial dosing and monitoring in ICUs. J Antimicrob Chemother 70:2671–2677
Dellinger RP, Levy MM, Rhodes A, Annane D, Gerlach H, Opal SM, Sevransky JE, Sprung CL, Douglas IS, Jaeschke R, Osborn TM, Nunnally ME, Townsend SR, Reinhart K, Kleinpell RM, Angus DC, Deutschman CS, Machado FR, Rubenfeld GD, Webb S, Beale RJ, Vincent JL, Moreno R (2013) Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock, 2012. Intensive Care Med 39:165–228
Felton TW, Hope WW, Roberts JA (2014) How severe is antibiotic pharmacokinetic variability in critically ill patients and what can be done about it. Diagn Microbiol Infect Dis 79:441–447
Roberts JA, Abdul-Aziz MH, Lipman J, Mouton JW, Vinks AA, Felton TW, Hope WW, Farkas A, Neely MN, Schentag JJ, Drusano G, Frey OR, Theuretzbacher U, Kuti JL (2014) Individualised antibiotic dosing for patients who are critically ill: challenges and potential solutions. Lancet Infect Dis 14(6):498–509
Kalil AC, Metersky ML, Klompas M, Muscedere J, Sweeney DA, Palmer LB, Napolitano LM, O’Grady NP, Bartlett JG, Carratalà J, El Solh AA, Ewig S, Fey PD, File TM, Restrepo MI, Roberts JA, Waterer GW, Cruse P, Knight SL, Brozek JL (2016) Management of Adults With Hospital-acquired and Ventilator-associated Pneumonia: 2016 Clinical Practice Guidelines by the Infectious Diseases Society of America and the American Thoracic Society. Clin Infect Dis 63:e61–e111
Dellinger RP, Carlet JM, Masur H, Gerlach H, Calandra T, Cohen J, Gea-Banacloche J, Keh D, Marshall JC, Parker MM, Ramsay G, Zimmerman JL, Vincent JL, Levy MM (2004) Surviving Sepsis Campaign guidelines for management of severe sepsis and septic shock. Intensive Care Med 30:536–555
Póvoa P, Salluh JI (2012) Biomarker-guided antibiotic therapy in adult critically ill patients: a critical review. Ann Intensive Care 2:32
Tsai D, Lipman J, Roberts JA (2015) Pharmacokinetic/pharmacodynamic considerations for the optimization of antimicrobial delivery in the critically ill. Curr Opin Crit Care 21:412–420
Goncalves-Pereira J, Povoa P (2011) Antibiotics in critically ill patients: a systematic review of the pharmacokinetics of beta-lactams. Crit Care 15:R206
Ulldemolins M, Roberts JA, Rello J, Paterson DL, Lipman J (2011) The effects of hypoalbuminaemia on optimizing antibacterial dosing in critically ill patients. Clin Pharmacokinet 50:99–110
Udy AA, Roberts JA, Lipman J (2011) Implications of augmented renal clearance in critically ill patients. Nat Rev Nephrol 7:539–543
Douglas IS (2016) New diagnostic methods for pneumonia in the ICU. Curr Opin Infect Dis 29:197–204
De Waele JJ, Schouten J, Dimopoulos G (2015) Understanding antibiotic stewardship for the critically ill. Intensive Care Med 42(12):2063–2065
Roberts JA, Lipman J (2009) Pharmacokinetic issues for antibiotics in the critically ill patient. Crit Care Med 37:840–851. Quiz 859
Jamal JA, Economou CJ, Lipman J, Roberts JA (2012) Improving antibiotic dosing in special situations in the ICU: burns, renal replacement therapy and extracorporeal membrane oxygenation. Curr Opin Crit Care 18:460–471
De Waele JJ, Lipman J, Carlier M, Roberts JA (2015) Subtleties in practical application of prolonged infusion of β-lactam antibiotics. Int J Antimicrob Agents 45:461–463
Abdul-Aziz MH, Lipman J, Akova M, Bassetti M, De Waele JJ, Dimopoulos G, Dulhunty J, Kaukonen KM, Koulenti D, Martin C, Montravers P, Rello J, Rhodes A, Starr T, Wallis SC, Roberts JA, SG DALI (2016) Is prolonged infusion of piperacillin/tazobactam and meropenem in critically ill patients associated with improved pharmacokinetic/pharmacodynamic and patient outcomes? An observation from the Defining Antibiotic Levels in Intensive care unit patients (DALI) cohort. J Antimicrob Chemother 71:196–207
Carlier M, Dumoulin A, Janssen A, Picavet S, Vanthuyne S, Van Eynde R, Vanholder R, Delanghe J, De Schoenmakere G, De Waele JJ, Hoste EA (2015) Comparison of different equations to assess glomerular filtration in critically ill patients. Intensive Care Med 41:427–435
Roberts JA, Taccone FS, Lipman J (2015) Understanding PK/PD. Intensive Care Med 42(11):1797–1800
Colin P, Eleveld DJ, Jonckheere S, Van Bocxlaer J, De Waele J, Vermeulen A (2016) What about confidence intervals? A word of caution when interpreting PTA simulations. J Antimicrob Chemother 71:2502–2508
Sime FB, Roberts MS, Roberts JA (2015) Optimization of dosing regimens and dosing in special populations. Clin Microbiol Infect 21(10):886–893
Huttner A, Harbarth S, Hope WW, Lipman J, Roberts JA (2015) Therapeutic drug monitoring of the β-lactam antibiotics: what is the evidence and which patients should we be using it for. J Antimicrob Chemother 70:3178–3183
Roberts JA, Taccone FS, Udy AA, Vincent JL, Jacobs F, Lipman J (2011) Vancomycin dosing in critically ill patients: robust methods for improved continuous-infusion regimens. Antimicrob Agents Chemother 55:2704–2709
Carlier M, Stove V, Wallis SC, De Waele JJ, Verstraete AG, Lipman J, Roberts JA (2015) Assays for therapeutic drug monitoring of β-lactam antibiotics: a structured review. Int J Antimicrob Agents 46:367–375
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De Waele, J.J. (2018). Generic and Optimized Antibacterial Dosing Strategies in the Critically Ill. In: Udy, A., Roberts, J., Lipman, J. (eds) Antibiotic Pharmacokinetic/Pharmacodynamic Considerations in the Critically Ill. Adis, Singapore. https://doi.org/10.1007/978-981-10-5336-8_10
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