Cargando…

Optimizing Antimicrobial Drug Dosing in Critically Ill Patients

A fundamental step in the successful management of sepsis and septic shock is early empiric antimicrobial therapy. However, for this to be effective, several decisions must be addressed simultaneously: (1) antimicrobial choices should be adequate, covering the most probable pathogens; (2) they shoul...

Descripción completa

Detalles Bibliográficos
Autores principales: Póvoa, Pedro, Moniz, Patrícia, Pereira, João Gonçalves, Coelho, Luís
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8305961/
https://www.ncbi.nlm.nih.gov/pubmed/34203510
http://dx.doi.org/10.3390/microorganisms9071401
_version_ 1783727696116711424
author Póvoa, Pedro
Moniz, Patrícia
Pereira, João Gonçalves
Coelho, Luís
author_facet Póvoa, Pedro
Moniz, Patrícia
Pereira, João Gonçalves
Coelho, Luís
author_sort Póvoa, Pedro
collection PubMed
description A fundamental step in the successful management of sepsis and septic shock is early empiric antimicrobial therapy. However, for this to be effective, several decisions must be addressed simultaneously: (1) antimicrobial choices should be adequate, covering the most probable pathogens; (2) they should be administered in the appropriate dose, (3) by the correct route, and (4) using the correct mode of administration to achieve successful concentration at the infection site. In critically ill patients, antimicrobial dosing is a common challenge and a frequent source of errors, since these patients present deranged pharmacokinetics, namely increased volume of distribution and altered drug clearance, which either increased or decreased. Moreover, the clinical condition of these patients changes markedly over time, either improving or deteriorating. The consequent impact on drug pharmacokinetics further complicates the selection of correct drug schedules and dosing during the course of therapy. In recent years, the knowledge of pharmacokinetics and pharmacodynamics, drug dosing, therapeutic drug monitoring, and antimicrobial resistance in the critically ill patients has greatly improved, fostering strategies to optimize therapeutic efficacy and to reduce toxicity and adverse events. Nonetheless, delivering adequate and appropriate antimicrobial therapy is still a challenge, since pathogen resistance continues to rise, and new therapeutic agents remain scarce. We aim to review the available literature to assess the challenges, impact, and tools to optimize individualization of antimicrobial dosing to maximize exposure and effectiveness in critically ill patients.
format Online
Article
Text
id pubmed-8305961
institution National Center for Biotechnology Information
language English
publishDate 2021
publisher MDPI
record_format MEDLINE/PubMed
spelling pubmed-83059612021-07-25 Optimizing Antimicrobial Drug Dosing in Critically Ill Patients Póvoa, Pedro Moniz, Patrícia Pereira, João Gonçalves Coelho, Luís Microorganisms Review A fundamental step in the successful management of sepsis and septic shock is early empiric antimicrobial therapy. However, for this to be effective, several decisions must be addressed simultaneously: (1) antimicrobial choices should be adequate, covering the most probable pathogens; (2) they should be administered in the appropriate dose, (3) by the correct route, and (4) using the correct mode of administration to achieve successful concentration at the infection site. In critically ill patients, antimicrobial dosing is a common challenge and a frequent source of errors, since these patients present deranged pharmacokinetics, namely increased volume of distribution and altered drug clearance, which either increased or decreased. Moreover, the clinical condition of these patients changes markedly over time, either improving or deteriorating. The consequent impact on drug pharmacokinetics further complicates the selection of correct drug schedules and dosing during the course of therapy. In recent years, the knowledge of pharmacokinetics and pharmacodynamics, drug dosing, therapeutic drug monitoring, and antimicrobial resistance in the critically ill patients has greatly improved, fostering strategies to optimize therapeutic efficacy and to reduce toxicity and adverse events. Nonetheless, delivering adequate and appropriate antimicrobial therapy is still a challenge, since pathogen resistance continues to rise, and new therapeutic agents remain scarce. We aim to review the available literature to assess the challenges, impact, and tools to optimize individualization of antimicrobial dosing to maximize exposure and effectiveness in critically ill patients. MDPI 2021-06-28 /pmc/articles/PMC8305961/ /pubmed/34203510 http://dx.doi.org/10.3390/microorganisms9071401 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Review
Póvoa, Pedro
Moniz, Patrícia
Pereira, João Gonçalves
Coelho, Luís
Optimizing Antimicrobial Drug Dosing in Critically Ill Patients
title Optimizing Antimicrobial Drug Dosing in Critically Ill Patients
title_full Optimizing Antimicrobial Drug Dosing in Critically Ill Patients
title_fullStr Optimizing Antimicrobial Drug Dosing in Critically Ill Patients
title_full_unstemmed Optimizing Antimicrobial Drug Dosing in Critically Ill Patients
title_short Optimizing Antimicrobial Drug Dosing in Critically Ill Patients
title_sort optimizing antimicrobial drug dosing in critically ill patients
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8305961/
https://www.ncbi.nlm.nih.gov/pubmed/34203510
http://dx.doi.org/10.3390/microorganisms9071401
work_keys_str_mv AT povoapedro optimizingantimicrobialdrugdosingincriticallyillpatients
AT monizpatricia optimizingantimicrobialdrugdosingincriticallyillpatients
AT pereirajoaogoncalves optimizingantimicrobialdrugdosingincriticallyillpatients
AT coelholuis optimizingantimicrobialdrugdosingincriticallyillpatients