Individualised antibiotic dosing for patients who are critically ill: Challenges and potential solutions

Roberts, Jason A., Abdul-Aziz, Mohd H., Lipman, Jeffrey, Mouton, Johan W., Vinks, Alexander ., Felton, Timothy W., Hope, William W., Farkas, Andras, Neely, Michael N., Schentag, Jerome J., Drusano, George, Frey, Otto R., Theuretzbacher, Ursula and Kuti, Joseph L. (2014) Individualised antibiotic dosing for patients who are critically ill: Challenges and potential solutions. The Lancet Infectious Diseases, 14 6: 498-509. doi:10.1016/S1473-3099(14)70036-2


Author Roberts, Jason A.
Abdul-Aziz, Mohd H.
Lipman, Jeffrey
Mouton, Johan W.
Vinks, Alexander .
Felton, Timothy W.
Hope, William W.
Farkas, Andras
Neely, Michael N.
Schentag, Jerome J.
Drusano, George
Frey, Otto R.
Theuretzbacher, Ursula
Kuti, Joseph L.
Title Individualised antibiotic dosing for patients who are critically ill: Challenges and potential solutions
Journal name The Lancet Infectious Diseases   Check publisher's open access policy
ISSN 1473-3099
1474-4457
Publication date 2014-01-01
Year available 2014
Sub-type Critical review of research, literature review, critical commentary
DOI 10.1016/S1473-3099(14)70036-2
Open Access Status DOI
Volume 14
Issue 6
Start page 498
End page 509
Total pages 12
Place of publication London, United Kingdom
Publisher Lancet Publishing Group
Language eng
Subject 2725 Infectious Diseases
Abstract Infections in critically ill patients are associated with persistently poor clinical outcomes. These patients have severely altered and variable antibiotic pharmacokinetics and are infected by less susceptible pathogens. Antibiotic dosing that does not account for these features is likely to result in suboptimum outcomes. In this Review, we explore the challenges related to patients and pathogens that contribute to inadequate antibiotic dosing and discuss how to implement a process for individualised antibiotic therapy that increases the accuracy of dosing and optimises care for critically ill patients. To improve antibiotic dosing, any physiological changes in patients that could alter antibiotic concentrations should first be established; such changes include altered fluid status, changes in serum albumin concentrations and renal and hepatic function, and microvascular failure. Second, antibiotic susceptibility of pathogens should be confirmed with microbiological techniques. Data for bacterial susceptibility could then be combined with measured data for antibiotic concentrations (when available) in clinical dosing software, which uses pharmacokinetic/pharmacodynamic derived models from critically ill patients to predict accurately the dosing needs for individual patients. Individualisation of dosing could optimise antibiotic exposure and maximise effectiveness.
Keyword Infectious Diseases
Infectious Diseases
INFECTIOUS DISEASES
Q-Index Code C1
Q-Index Status Confirmed Code
Grant ID R01 HD070886
CS/08/08/10
G1000417/94909
P01 AI060908
G1000417
R01 GM068968
R01 AI079578
Institutional Status UQ

Document type: Journal Article
Sub-type: Critical review of research, literature review, critical commentary
Collections: UQ Centre for Clinical Research Publications
Official 2015 Collection
School of Medicine Publications
 
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