Optimizing antibiotic use in the intensive care unit

Ulldemolins, Marta, Roberts, Jason A. and Lipman, Jeffrey (2010) Optimizing antibiotic use in the intensive care unit. Clinical Pulmonary Medicine, 17 4: 162-169. doi:10.1097/CPM.0b013e3181e47953

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Author Ulldemolins, Marta
Roberts, Jason A.
Lipman, Jeffrey
Title Optimizing antibiotic use in the intensive care unit
Journal name Clinical Pulmonary Medicine   Check publisher's open access policy
ISSN 1068-0640
Publication date 2010-07
Sub-type Article (original research)
DOI 10.1097/CPM.0b013e3181e47953
Volume 17
Issue 4
Start page 162
End page 169
Total pages 8
Place of publication Baltimore, MD, U.S.A.
Publisher Lippincott Willams and Wilkins
Collection year 2011
Language eng
Subject 920109 Infectious Diseases
111502 Clinical Pharmacology and Therapeutics
Abstract Efforts directed at maximizing use of the existing antibiotic armamentarium are essential due to persisting increases in antibiotic resistance and the limited number of new antibiotics in development. The intensive care unit (ICU) is an especially complex environment deserving of specific focus. Antibiotic prescription in the ICU is difficult because of the presence of poorly susceptible pathogens, and the dynamic physiology of critically ill patients, which combine to alter bacterial-antibiotic interaction leading to suboptimal treatment of infections. The main objective of this article is to discuss the principles for optimization of antibiotic therapy, specifically focusing on altered pharmacokinetics in the critically ill patient, and the rationale for dosage adjustments. Optimizing antibiotic therapy involves early initiation of appropriate antibiotics, de-escalation where appropriate, minimization of duration of therapy, and avoidance of drug interactions. Furthermore, current opinion suggests that there remains significant capacity for improved antibiotic dosing in the ICU. Application of knowledge of the effect of pathophysiology on drug pharmacokinetics and dose adjustments that adhere to pharmacodynamic principles will facilitate improved antibiotic dosing in these "at risk" ICU patients. Copyright © 2010 by Lippincott Williams & Wilkins.
Keyword Bacterial resistance
Critically ill patient
Dosing
Pharmacodynamics
Pharmacokinetics
Safety
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2011 Collection
School of Medicine Publications
 
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Created: Tue, 22 Feb 2011, 14:40:10 EST by Sia Athanasas on behalf of Anaesthesiology and Critical Care - RBWH