The effects of hypoalbuminaemia on optimizing antibacterial dosing in critically ill patients

Ulldemolins, Marta, Roberts, Jason A., Rello, Jordi, Paterson, David L. and Lipman, Jeffrey (2011) The effects of hypoalbuminaemia on optimizing antibacterial dosing in critically ill patients. Clinical Pharmacokinetics, 50 2: 99-110. doi:10.2165/11539220-000000000-00000


Author Ulldemolins, Marta
Roberts, Jason A.
Rello, Jordi
Paterson, David L.
Lipman, Jeffrey
Title The effects of hypoalbuminaemia on optimizing antibacterial dosing in critically ill patients
Journal name Clinical Pharmacokinetics   Check publisher's open access policy
ISSN 0312-5963
1179-1926
Publication date 2011-02-01
Sub-type Article (original research)
DOI 10.2165/11539220-000000000-00000
Volume 50
Issue 2
Start page 99
End page 110
Total pages 12
Place of publication Auckland, New Zealand
Publisher Adis International
Collection year 2012
Language eng
Formatted abstract
Low serum albumin levels are very common in critically ill patients, with reported incidences as high as 40–50%. This condition appears to be associated with alterations in the degree of protein binding of many highly protein-bound antibacterials, which lead to altered pharmacokinetics and pharmacodynamics, although this topic is infrequently considered in daily clinical practice. The effects of hypoalbuminaemia on pharmacokinetics are driven by the decrease in the extent of antibacterial bound to albumin, which increases the unbound fraction of the drug. Unlike the fraction bound to plasma proteins, the unbound fraction is the only fraction available for distribution and clearance from the plasma (central compartment). Hence, hypoalbuminaemia is likely to increase the apparent total volume of distribution (Vd) and clearance (CL) of a drug, which would translate to lower antibacterial exposures that might compromise the attainment of pharmacodynamic targets, especially for time-dependent antibacterials. The effect of hypoalbuminaemia on unbound concentrations is also likely to have an important impact on pharmacodynamics, but there is very little information available on this area.
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: UQ Centre for Clinical Research Publications
Official 2012 Collection
School of Medicine Publications
 
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Created: Thu, 22 Sep 2011, 13:46:14 EST by Matthew Lamb on behalf of School of Medicine