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

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

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...

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Main Authors: Roberts, Jason A., Abdul Aziz, Mohd. Hafiz, Lipman, Jeffrey, Mouton, Johan W., Vinks, Alexander A., Felton, Timothy W., Hope, William W., Farkas, Andras, Neely , Michael N., Schentag, Jerome J., Drusano, George, Frey, Otto R., Theuretzbacher, Ursula, Kuti, Joseph L.
Format: Article
Language:English
Published: Elsevier 2014
Subjects:
RM Therapeutics. Pharmacology
Online Access:http://irep.iium.edu.my/36783/
http://irep.iium.edu.my/36783/
http://irep.iium.edu.my/36783/
http://irep.iium.edu.my/36783/1/14733099-S1473309914X70702-S1473309914700362-main.pdf
id iium-36783
recordtype eprints
spelling iium-367832018-06-20T00:47:03Z http://irep.iium.edu.my/36783/ Individualised antibiotic dosing for patients who are critically ill: challenges and potential solutions Roberts, Jason A. Abdul Aziz, Mohd. Hafiz Lipman, Jeffrey Mouton, Johan W. Vinks, Alexander A. Felton, Timothy W. Hope, William W. Farkas, Andras Neely , Michael N. Schentag, Jerome J. Drusano, George Frey, Otto R. Theuretzbacher, Ursula Kuti, Joseph L. RM Therapeutics. Pharmacology 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. Elsevier 2014-04-24 Article PeerReviewed application/pdf en http://irep.iium.edu.my/36783/1/14733099-S1473309914X70702-S1473309914700362-main.pdf Roberts, Jason A. and Abdul Aziz, Mohd. Hafiz and Lipman, Jeffrey and Mouton, Johan W. and Vinks, Alexander A. and Felton, Timothy W. and Hope, William W. and Farkas, Andras and Neely , Michael N. and Schentag, Jerome J. and Drusano, George and Frey, Otto R. and Theuretzbacher, Ursula and Kuti, Joseph L. (2014) Individualised antibiotic dosing for patients who are critically ill: challenges and potential solutions. The Lancet Infectious Disease, 14 (6). pp. 498-509. ISSN 1473-3099 http://www.thelancet.com/journals/laninf/article/PIIS1473-3099%2814%2970036-2/abstract 0.1016/ S1473-3099(14)70036-2
repository_type Digital Repository
institution_category Local University
institution International Islamic University Malaysia
building IIUM Repository
collection Online Access
language English
topic RM Therapeutics. Pharmacology
spellingShingle RM Therapeutics. Pharmacology
Roberts, Jason A.
Abdul Aziz, Mohd. Hafiz
Lipman, Jeffrey
Mouton, Johan W.
Vinks, Alexander A.
Felton, Timothy W.
Hope, William W.
Farkas, Andras
Neely , Michael N.
Schentag, Jerome J.
Drusano, George
Frey, Otto R.
Theuretzbacher, Ursula
Kuti, Joseph L.
Individualised antibiotic dosing for patients who are critically ill: challenges and potential solutions
description 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.
format Article
author Roberts, Jason A.
Abdul Aziz, Mohd. Hafiz
Lipman, Jeffrey
Mouton, Johan W.
Vinks, Alexander A.
Felton, Timothy W.
Hope, William W.
Farkas, Andras
Neely , Michael N.
Schentag, Jerome J.
Drusano, George
Frey, Otto R.
Theuretzbacher, Ursula
Kuti, Joseph L.
author_facet Roberts, Jason A.
Abdul Aziz, Mohd. Hafiz
Lipman, Jeffrey
Mouton, Johan W.
Vinks, Alexander A.
Felton, Timothy W.
Hope, William W.
Farkas, Andras
Neely , Michael N.
Schentag, Jerome J.
Drusano, George
Frey, Otto R.
Theuretzbacher, Ursula
Kuti, Joseph L.
author_sort Roberts, Jason A.
title Individualised antibiotic dosing for patients who are critically ill: challenges and potential solutions
title_short Individualised antibiotic dosing for patients who are critically ill: challenges and potential solutions
title_full Individualised antibiotic dosing for patients who are critically ill: challenges and potential solutions
title_fullStr Individualised antibiotic dosing for patients who are critically ill: challenges and potential solutions
title_full_unstemmed Individualised antibiotic dosing for patients who are critically ill: challenges and potential solutions
title_sort individualised antibiotic dosing for patients who are critically ill: challenges and potential solutions
publisher Elsevier
publishDate 2014
url http://irep.iium.edu.my/36783/
http://irep.iium.edu.my/36783/
http://irep.iium.edu.my/36783/
http://irep.iium.edu.my/36783/1/14733099-S1473309914X70702-S1473309914700362-main.pdf
first_indexed 2023-09-18T20:52:44Z
last_indexed 2023-09-18T20:52:44Z
_version_ 1777410102070870016

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