Pharmacokinetic/pharmacodynamic considerations for the optimization of antimicrobial delivery in the critically ill

Tsai, Danny, Lipman, Jeffrey and Roberts, Jason A. (2015) Pharmacokinetic/pharmacodynamic considerations for the optimization of antimicrobial delivery in the critically ill. Current Opinion in Critical Care, 21 5: 412-420. doi:10.1097/MCC.0000000000000229


Author Tsai, Danny
Lipman, Jeffrey
Roberts, Jason A.
Title Pharmacokinetic/pharmacodynamic considerations for the optimization of antimicrobial delivery in the critically ill
Journal name Current Opinion in Critical Care   Check publisher's open access policy
ISSN 1070-5295
1531-7072
Publication date 2015-10-01
Year available 2015
Sub-type Critical review of research, literature review, critical commentary
DOI 10.1097/MCC.0000000000000229
Open Access Status Not Open Access
Volume 21
Issue 5
Start page 412
End page 420
Total pages 9
Place of publication London, United Kingdom
Publisher Lippincott Williams & Wilkins
Language eng
Abstract Purpose of review
Formatted abstract
Purpose of review: Antimicrobials are very commonly used drugs in the intensive care setting. Extensive research has been conducted in recent years to describe their pharmacokinetics/pharmacodynamics in order to maximize the pharmacological benefit and patient outcome. Translating these new findings into clinical practice is encouraged.

Recent findings: This article will discuss mechanistic data on factors causing changes in antimicrobial pharmacokinetics in critically ill patients, such as the phenomena of augmented renal clearance as well as the effects of hypoalbuminemia, renal replacement therapy, and extracorporeal membrane oxygenation. Failure to achieve clinical cure has been correlated with pharmacokinetics/pharmacodynamics target nonattainment, and a recent meta-analysis suggests an association between dosing strategies aimed at optimizing antimicrobial pharmacokinetics/pharmacodynamics with improvement in clinical cure and survival. Novel dosing strategies including therapeutic drug monitoring are also now being tested to address challenges in the optimization of antimicrobial pharmacokinetics/pharmacodynamics.

Summary: Optimization of antimicrobial dosing in accordance with pharmacokinetics/pharmacodynamics targets can improve survival and clinical cure. Dosing regimens for critically ill patients should aim for pharmacokinetics/pharmacodynamics target attainment by utilizing altered dosing strategies including adaptive feedback using therapeutic drug monitoring.
Keyword Antibacterial
Antimicrobial
Critically ill
Pharmacodynamics
Pharmacokinetics
Q-Index Code C1
Q-Index Status Provisional Code
Grant ID APP1048652
Institutional Status UQ

Document type: Journal Article
Sub-type: Critical review of research, literature review, critical commentary
Collections: Official 2016 Collection
School of Medicine Publications
School of Pharmacy Publications
 
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