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Title: Pharmacokinetic/pharmacodynamic considerations for the optimization of antimicrobial delivery in the critically ill.
Authors: Tsai, Danny
Lipman, Jeffrey
Roberts, Jason A
Affiliation: aBurns, Trauma and Critical Care Research Centre, School of Medicine, The University of Queensland, Brisbane, Queensland bDepartment of Intensive Care Medicine cPharmacy Department, Alice Springs Hospital, Alice Springs, Northern Territory dDepartment of Intensive Care Medicine ePharmacy Department, The Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia fDepartment of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, United Kingdom..
Issue Date: Oct-2015
Citation: Current opinion in critical care 2015-10; 21(5): 412-20
Abstract: 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. 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. 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.
DOI: 10.1097/MCC.0000000000000229
Type: Journal Article
Research Support, Non-U.S. Gov't
Subjects: Anti-Bacterial Agents
Clinical Protocols
Clinical Trials as Topic
Critical Illness
Drug Dosage Calculations
Extracorporeal Membrane Oxygenation
Kidney Function Tests
Microbial Sensitivity Tests
Renal Replacement Therapy
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