How severe is antibiotic pharmacokinetic variability in critically ill patients and what can be done about it?

Felton, T. W., Hope, W. W. and Roberts, J. A. (2014) How severe is antibiotic pharmacokinetic variability in critically ill patients and what can be done about it?. Diagnostic Microbiology and Infectious Disease, 79 4: 441-447. doi:10.1016/j.diagmicrobio.2014.04.007

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Author Felton, T. W.
Hope, W. W.
Roberts, J. A.
Title How severe is antibiotic pharmacokinetic variability in critically ill patients and what can be done about it?
Journal name Diagnostic Microbiology and Infectious Disease   Check publisher's open access policy
ISSN 1879-0070
0732-8893
Publication date 2014-08
Year available 2014
Sub-type Article (original research)
DOI 10.1016/j.diagmicrobio.2014.04.007
Open Access Status
Volume 79
Issue 4
Start page 441
End page 447
Total pages 7
Place of publication Philadelphia, PA, United States
Publisher Elsevier
Collection year 2015
Language eng
Formatted abstract
The pharmacokinetics (PK) of antimicrobial agents administered to critically ill patients exhibit marked variability. This variability results from pathophysiological changes that occur in critically ill patients. Changes in volume of distribution, clearance, and tissue penetration all affect the drug concentrations at the site of infection. PK-pharmacodynamic indices (fCmax:MIC; AUC0–24:MIC; fT>MIC; fCmin:MIC) for both antimicrobial effect and suppression of emergence of resistance are described for many antimicrobial drugs. Changing the regimen by which antimicrobial drugs are delivered can help overcome the PK variability and optimise target attainment. This will deliver optimised antimicrobial chemotherapy to individual critically ill patients. Delivery of β-lactams antimicrobial agents by infusions, rather than bolus dosing, is effective at increasing the duration of the dosing interval that the drug concentration is above the MIC. Therapeutic drug monitoring, utilising population PK mathematical models with Bayesian estimation, can also be used to optimise regimens following measurement of plasma drug concentrations. Clinical trials are required to establish if patient outcomes can be improved by implementing these techniques.
Keyword Pharmacokinetics
Pharmacodynamics
Critical care
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2015 Collection
School of Medicine Publications
 
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