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Review

Optimizing Antimicrobial Drug Dosing in Critically Ill Patients

1
Polyvalent Intensive Care Unit, Sao Francisco Xavier Hospital, CHLO, 1449-005 Lisbon, Portugal
2
Comprehensive Health Research Centre (CHRC), Nova Medical School, New University of Lisbon, 1169-056 Lisbon, Portugal
3
Center for Clinical Epidemiology and Research Unit of Clinical Epidemiology, OUH Odense University Hospital, 5000 Odense, Denmark
4
Intensive Care Unit, Vila Franca de Xira Hospital, 2600-009 Vila Franca de Xira, Portugal
*
Author to whom correspondence should be addressed.
Academic Editor: Savino Spadaro
Microorganisms 2021, 9(7), 1401; https://doi.org/10.3390/microorganisms9071401
Received: 2 June 2021 / Revised: 25 June 2021 / Accepted: 25 June 2021 / Published: 28 June 2021
(This article belongs to the Special Issue Complex Infectious Issues 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 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. View Full-Text
Keywords: pharmacokinetics; antibiotics; sepsis pharmacokinetics; antibiotics; sepsis
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MDPI and ACS Style

Póvoa, P.; Moniz, P.; Pereira, J.G.; Coelho, L. Optimizing Antimicrobial Drug Dosing in Critically Ill Patients. Microorganisms 2021, 9, 1401. https://doi.org/10.3390/microorganisms9071401

AMA Style

Póvoa P, Moniz P, Pereira JG, Coelho L. Optimizing Antimicrobial Drug Dosing in Critically Ill Patients. Microorganisms. 2021; 9(7):1401. https://doi.org/10.3390/microorganisms9071401

Chicago/Turabian Style

Póvoa, Pedro, Patrícia Moniz, João Gonçalves Pereira, and Luís Coelho. 2021. "Optimizing Antimicrobial Drug Dosing in Critically Ill Patients" Microorganisms 9, no. 7: 1401. https://doi.org/10.3390/microorganisms9071401

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