Pharmacokinetic issues for antibiotics in the critically ill patient

Roberts, Jason A. and Lipman, Jeffrey (2009) Pharmacokinetic issues for antibiotics in the critically ill patient. Critical Care Medicine, 37 3: 840-851. doi:10.1097/CCM.0b013e3181961bff


Author Roberts, Jason A.
Lipman, Jeffrey
Title Pharmacokinetic issues for antibiotics in the critically ill patient
Journal name Critical Care Medicine   Check publisher's open access policy
ISSN 0090-3493
1530-0293
Publication date 2009-03
Sub-type Critical review of research, literature review, critical commentary
DOI 10.1097/CCM.0b013e3181961bff
Volume 37
Issue 3
Start page 840
End page 851
Total pages 12
Place of publication Baltimore, MD, USA
Publisher Lippincott Williams and Wilkins
Language eng
Subject 110309 Infectious Diseases
110310 Intensive Care
Formatted abstract
Objective: To discuss the altered pharmacokinetic properties of selected antibiotics in critically ill patients and to develop basic dose adjustment principles for this patient population.
Data Sources: PubMed, EMBASE, and the Cochrane-Controlled Trial Register.
Study Selection: Relevant papers that reported pharmacokinetics of selected antibiotic classes in critically ill patients and antibiotic pharmacodynamic properties were reviewed. Antibiotics and/or antibiotic classes reviewed included aminoglycosides, [beta]-lactams (including carbapenems), glycopeptides, fluoroquinolones, tigecycline, linezolid, lincosamides, and colistin.
Data Synthesis: Antibiotics can be broadly categorized according to their solubility characteristics which can, in turn, help describe possible altered pharmacokinetics that can be caused by the pathophysiological changes common to critical illness. Hydrophilic antibiotics (e.g., aminoglycosides, [beta]-lactams, glycopeptides, and colistin) are mostly affected with the pathphysiological changes observed in critically ill patients with increased volumes of distribution and altered drug clearance (related to changes in creatinine clearance). Lipophilic antibiotics (e.g., fluoroquinolones, macrolides, tigecycline, and lincosamides) have lesser volume of distribution alterations, but may develop altered drug clearances. Using antibiotic pharmacodynamic bacterial kill characteristics, altered dosing regimens can be devised that also account for such pharmacokinetic changes.
Conclusions: Knowledge of antibiotic pharmacodynamic properties and the potential altered antibiotic pharmacokinetics in critically ill patients can allow the intensivist to develop individualized dosing regimens. Specifically, for renally cleared drugs, measured creatinine clearance can be used to drive many dose adjustments. Maximizing clinical outcomes and minimizing antibiotic resistance using individualized doses may be best achieved with therapeutic drug monitoring.
Keyword Pharmacokinetics
Critically ill
Pharmacodynamic (PD)
Antibiotics
Dosing
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

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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Created: Thu, 18 Feb 2010, 14:22:26 EST by Laura McTaggart on behalf of School of Medicine