Right dose, right now: customized drug dosing in the critically ill

Roberts, Jason A., Kumar, Anand and Lipman, Jeffrey (2017) Right dose, right now: customized drug dosing in the critically ill. Critical Care Medicine, 45 2: 331-336. doi:10.1097/CCM.0000000000002210

Author Roberts, Jason A.
Kumar, Anand
Lipman, Jeffrey
Title Right dose, right now: customized drug dosing in the critically ill
Journal name Critical Care Medicine   Check publisher's open access policy
ISSN 1530-0293
Publication date 2017-02-01
Year available 2017
Sub-type Article (original research)
DOI 10.1097/CCM.0000000000002210
Open Access Status Not yet assessed
Volume 45
Issue 2
Start page 331
End page 336
Total pages 6
Place of publication Philadelphia, PA, United States
Publisher Lippincott Williams & Wilkins
Language eng
Subject 2706 Critical Care and Intensive Care Medicine
Abstract Drugs are key weapons that clinicians have to battle against the profound pathologies encountered in critically ill patients. Antibiotics in particular are commonly used and can improve patient outcomes dramatically. Despite this, there are strong opportunities for further reducing the persisting poor outcomes for infected critically ill patients. However, taking these next steps for improving patient care requires a new approach to antibiotic therapy. Giving the right dose is highly likely to increase the probability of clinical cure from infection and suppress the emergence of resistant pathogens. Furthermore, in some patients with higher levels of sickness severity, reduced mortality from an optimized approach to antibiotic use could also occur. To enable optimized dosing, the use of customized dosing regimens through either evidence-based dosing nomograms or preferably through the use of dosing software supplemented by therapeutic drug monitoring data should be embedded into daily practice. These customized dosing regimens should also be given as soon as practicable as reduced time to initiation of therapy has been shown to improve patient survival, particularly in the presence of septic shock. However, robust data supporting these logical approaches to therapy, which may deliver the next step change improvement for treatment of infections in critically ill patients, are lacking. Large prospective studies of patient survival and health system costs are now required to determine the value of customized antibiotic dosing, that is, giving the right dose at the right time.
Keyword Antibiotics
Intensive care
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

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