Improving antibiotic dosing in special situations in the ICU: burns, renal replacement therapy and extracorporeal membrane oxygenation

Jamal, Janattul-Ain, Economou, Caleb J. P., Lipman, Jeffrey and Roberts, Jason A. (2012) Improving antibiotic dosing in special situations in the ICU: burns, renal replacement therapy and extracorporeal membrane oxygenation. Current Opinion in Critical Care, 18 5: 460-471.

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Author Jamal, Janattul-Ain
Economou, Caleb J. P.
Lipman, Jeffrey
Roberts, Jason A.
Title Improving antibiotic dosing in special situations in the ICU: burns, renal replacement therapy and extracorporeal membrane oxygenation
Journal name Current Opinion in Critical Care   Check publisher's open access policy
ISSN 1070-5295
1531-7072
Publication date 2012-10
Sub-type Critical review of research, literature review, critical commentary
DOI 10.1097/MCC.0b013e32835685ad
Volume 18
Issue 5
Start page 460
End page 471
Total pages 12
Place of publication Philadelphia, PA United States
Publisher Lippincott Willams and Wilkins
Collection year 2012
Language eng
Formatted abstract Purpose of review Antibiotic dosing for critically ill patients that is derived from other patient groups is likely to be suboptimal because of significant antibiotic pharmacokinetic changes, particularly in terms of drug volume of distribution and clearance. Organ support techniques including renal replacement therapy (RRT) and extracorporeal membrane oxygenation (ECMO) increase the pharmacokinetic variability. This article reviews the recently published antibiotic pharmacokinetic data associated with burns patients, those receiving continuous RRT (CRRT), sustained low-efficiency dialysis (SLED) and ECMO. Recent findings These groups develop increases in volume of distribution that necessitate the use of higher initial doses to rapidly achieve therapeutic antibiotic concentrations. Burns patients have supranormal drug clearances requiring more frequent administration of antibiotics. Patients receiving CRRT or SLED have variable drug clearances related to different equipment and RRT settings at different institutions. ECMO presents a different challenge because there is such a dearth of data with higher than standard doses potentially required, even in the presence of end-organ failure. Summary In the context of such variable pharmacokinetics, a guideline approach to dosing remains elusive because of insufficient available data and, therefore, use of therapeutic drug monitoring should be considered advantageous where possible.
Keyword Critical care
Extracorporeal membrane oxygenation
Pharmacokinetics
Renal Replacement Therapy
Sustained low efficiency dialysis
Q-Index Code CX
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Critical review of research, literature review, critical commentary
Collections: Non HERDC
School of Medicine Publications
 
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