Pharmacological principles of antibiotic prescription in the critically ill

Pinder, M., Bellomo, R. and Lipman, Jeffrey (2002) Pharmacological principles of antibiotic prescription in the critically ill. Anaesth Intensive Care, 30 2: 134-144.


Author Pinder, M.
Bellomo, R.
Lipman, Jeffrey
Title Pharmacological principles of antibiotic prescription in the critically ill
Journal name Anaesth Intensive Care   Check publisher's open access policy
ISSN 0310-057X
Publication date 2002-04-01
Sub-type Critical review of research, literature review, critical commentary
Volume 30
Issue 2
Start page 134
End page 144
Total pages 11
Place of publication Melbourne
Publisher Australian Association of Anaesthetists
Language eng
Subject 110310 Intensive Care
Abstract The goal of antimicrobial prescription is to achieve effective drug concentrations. Standard antimicrobial dosing regimens are based on research peiformed often decades ago and for the most part with patients who were not critically ill. More recent insights into antibiotic activity (e.g. the importance of high peak/MIC ratios for aminoglycosides and time above MIC for j3-lactam antibiotics), drug pharmacokinetics (e.g. increased volume of distribution and altered clearances) and the pathogenesis of sepsis (e.g. third space losses and altered creatinine clearances) have made re-evaluation ofdosing regimens necessary for the critically ill. The inflammatory response associated with sepsis results in a rapid decrease in serum albumin levels, large fluid shifts and third space losses, initially with a high cardiac output. In turn these changes result in increased creatinine clearance and increased renal drug clearance. Unless these effects are offset by ensuing renal and/or hepatic impairment, with subsequent drug accumulation, antibiotic levels may be too low for optimal efficacy. The institution of continuous renal replacement therapy separately affects antibiotic clearances, and therefore dosing, even further. This article reviews relevant literature and offers principles for more effective and appropriate antibiotic dosing in the critically ill, based on the pharmacokinetic and pharmacodynamic principles of the main antibiotic groups (aminoglyosides, glycopeptides, j3-lactams, carbapenems and quinolones) and knowledge of the pathophysiology of the inflammatory response syndrome. Finally it also provides some guidance on the basic principles of drug prescription for patients receiving continuous renal replacement therapy.
Keyword Antibiotics
Intensive care unit
HaemofLltration
Acute renal failure
Pharmacokinetics
Pharmacodynamics
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Unknown
Additional Notes Review

Document type: Journal Article
Sub-type: Critical review of research, literature review, critical commentary
Collections: Excellence in Research Australia (ERA) - Collection
School of Medicine Publications
 
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Citation counts: TR Web of Science Citation Count  Cited 59 times in Thomson Reuters Web of Science Article | Citations
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Created: Thu, 19 Mar 2009, 21:34:34 EST by Ms Sarada Rao on behalf of Anaesthesiology and Critical Care - RBWH