Antibiotic resistance - what's dosing got to do with it?

Roberts, Jason A., Kruger, Peter, Paterson, David L. and Lipman, Jeffrey (2008) Antibiotic resistance - what's dosing got to do with it?. Critical Care Medicine, 36 8: 2433-2440. doi:10.1097/CCM.0b013e318180fe62


Author Roberts, Jason A.
Kruger, Peter
Paterson, David L.
Lipman, Jeffrey
Title Antibiotic resistance - what's dosing got to do with it?
Journal name Critical Care Medicine   Check publisher's open access policy
ISSN 0090-3493
1530-0293
Publication date 2008-08
Sub-type Critical review of research, literature review, critical commentary
DOI 10.1097/CCM.0b013e318180fe62
Volume 36
Issue 8
Start page 2433
End page 2440
Total pages 8
Editor J. Parrillo
J. C. Farmer
Place of publication Baltimore, MD, United States
Publisher Lippincott Williams & Wilkins
Collection year 2009
Language eng
Subject 110310 Intensive Care
110309 Infectious Diseases
Formatted abstract
Objective: This review seeks to identify original research articles that link antibiotic dosing and the development of antibiotic resistance for different antibiotic classes. Using this data, we seek to apply pharmacodynamic principles to assist clinical practice for suppressing the emergence of resistance. Concepts such as mutant selection window and mutant prevention concentration will be discussed.

Data Sources: PubMed, EMBASE, and the Cochrane Controlled Trial Register.

Study Selection
: All articles that related antibiotic doses and exposure to the formation of antibiotic resistance were reviewed.

Data Synthesis
: The escalation of antibiotic resistance continues worldwide, most prominently in patients in intensive care units. Data are emerging from in vitro and in vivo studies that suggest that inappropriately low antibiotic dosing may be contributing to the increasing rate of antibiotic resistance. Fluoroquinolones have widely been researched and publications on other antibiotic classes are emerging. Developing dosing regimens that adhere to pharmacodynamic principles and maximize antibiotic exposure is essential to reduce the increasing rate of antibiotic resistance.

Conclusions
: Antibiotic dosing must aim to address not only the bacteria isolated, but also the most resistant subpopulation in the colony, to prevent the advent of further resistant infections because of the inadvertent selection pressure of current dosing regimens. This may be achieved by maximizing antibiotic exposure by administering the highest recommended dose to the patient.
Copyright © 2008 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins
Keyword Antibiotic
Resistance
Dosing
Exposure
Pharmacodynamics
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Unknown

Document type: Journal Article
Sub-type: Critical review of research, literature review, critical commentary
Collections: Excellence in Research Australia (ERA) - Collection
School of Medicine Publications
 
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Citation counts: TR Web of Science Citation Count  Cited 114 times in Thomson Reuters Web of Science Article | Citations
Scopus Citation Count Cited 119 times in Scopus Article | Citations
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Created: Thu, 04 Jun 2009, 10:18:56 EST by Denise Wilson on behalf of Medicine - Princess Alexandra Hospital