How should we dose antibiotics for pneumonia in the ICU?

Udy, Andrew A., Roberts, Jason A. and Lipman, Jeffrey (2013) How should we dose antibiotics for pneumonia in the ICU?. Current Opinions in Infectious Diseases, 26 2: 189-195. doi:10.1097/QCO.0b013e32835d19e0

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Author Udy, Andrew A.
Roberts, Jason A.
Lipman, Jeffrey
Title How should we dose antibiotics for pneumonia in the ICU?
Journal name Current Opinions in Infectious Diseases   Check publisher's open access policy
ISSN 0951-7375
1473-6527
Publication date 2013-04
Year available 2013
Sub-type Article (original research)
DOI 10.1097/QCO.0b013e32835d19e0
Volume 26
Issue 2
Start page 189
End page 195
Total pages 7
Place of publication Philadelphia, PA United States
Publisher Lippincott Williams and Wilkins
Collection year 2014
Language eng
Formatted abstract
PURPOSE OF REVIEW: Pneumonia continues to be a common reason for, or complication of, ICU admission. Associated morbidity and mortality remain high, with an increasing incidence of multidrug-resistant organisms. Appropriate antibiotic therapy, both in terms of spectrum of cover and dose, remains the cornerstone of effective management.

RECENT FINDINGS:
Critically ill patients will frequently manifest significantly altered end-organ function, as compared with an ambulatory or ward-based setting. Such changes can have profound effects on antibiotic drug handling, promoting subtherapeutic concentrations, treatment failure or the selection of resistant organisms. Standard antibiotic regimens typically fail to consider such issues, with recent literature highlighting the need for improved dosing to achieve sufficient intrapulmonary concentrations, particularly in the setting of augmented elimination. Although recent clinical trials utilizing strategies that optimize drug exposure (either through the use of agents with improved penetration, or continuous infusions) demonstrate superior surrogate outcomes, a mortality benefit is still uncertain.

SUMMARY: Antibiotic dosing strategies that are adapted to a critical care environment are urgently needed, both to improve clinical outcomes and ensure therapeutic longevity. Similarly, study protocols investigating emerging antibiotics must also be designed accordingly, to prevent potential setbacks in drug availability.
Keyword Antibiotics
Critical illness
Dosing
Pneumonia
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ
Additional Notes accepted 27th Nov 2012

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2014 Collection
School of Medicine Publications
 
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Citation counts: TR Web of Science Citation Count  Cited 2 times in Thomson Reuters Web of Science Article | Citations
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Created: Mon, 17 Dec 2012, 17:41:52 EST by Sia Athanasas on behalf of Anaesthesiology and Critical Care - RBWH