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Antibiotics
Special Issues
Antimicrobial Stewardship and Optimizing Antibiotic Dose in Critically Ill Patients
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Antimicrobial Stewardship and Optimizing Antibiotic Dose in Critically Ill Patients

A special issue of Antibiotics (ISSN 2079-6382). This special issue belongs to the section "Pharmacokinetics and Pharmacodynamics of Drugs".

Deadline for manuscript submissions: closed (30 June 2025) | Viewed by 5524

Special Issue Editor

Prof. Dr. Barbara J. Philips

E-Mail Website
Guest Editor
Intensive Care Medicine, Brighton and Sussex Medical School, Brighton BN1 9PX, UK
Interests: critical care medicine; sepsis; scute kidney injury; endocrine; metabolic disturbances
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

The escalating crisis of antibiotic resistance, coupled with a decrease in the development of novel antibiotics, demands innovative approaches to improve current antimicrobial prescribing practices. This Special Issue focuses on antimicrobial stewardship and optimizing antibiotic dose in critically ill patients, highlighting the challenges clinicians face in striking the balance between effective therapy and minimizing antibiotic resistance.

In clinical practice, ensuring appropriate antibiotic dosing is essential for therapeutic success in critically ill patients. Critical illness has profound effects on the pharmacokinetics and pharmacodynamics of antibiotics. Patients are at an increased risk of both under- and overdosing of drugs, leading to either therapeutic failure, antibiotic resistance or toxicity. We suggest that the articles submitted to this Special Issue focus on the importance of individualizing antibiotic therapy, developing dynamic prescribing practices, incorporating clinical susceptibility data and employing pharmacokinetic/pharmacodynamic principles for dose optimization.

Additionally, this issue will cover the antimicrobial stewardship programs (ASPs) that promote responsible antibiotic use. By integrating these programs into the healthcare system, healthcare professionals can align their prescribing practices with evidence-based guidelines and minimize the development of resistant strains. The need for collaboration between different disciplines—such as infection control, microbiology, clinical pharmacy and therapeutics—is underscored throughout this issue to maximize the outcomes of ASPs.

Prof. Dr. Barbara J. Philips
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Antibiotics is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • antibiotics
  • antimicrobials
  • intensive care
  • critical care
  • sepsis
  • pharmacokinetics
  • pharmacodynamics
  • stewardship
  • beta-lactams
  • aminoglycosides
  • quinolones
  • cephalosporins
  • antifungal

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Further information on MDPI's Special Issue policies can be found here.

Published Papers (3 papers)

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Research

12 pages, 960 KiB  
Article
Intravenous Clarithromycin in Critically Ill Adults: A Population Pharmacokinetic Study
by Reya V. Shah, Karin Kipper, Emma H. Baker, Charlotte I. S. Barker, Isobel Oldfield, Harriet C. Davidson, Cleodie C. Swire, Barbara J. Philips, Atholl Johnston, Andrew Rhodes, Mike Sharland, Joseph F. Standing and Dagan O. Lonsdale
Antibiotics 2025, 14(6), 559; https://doi.org/10.3390/antibiotics14060559 - 30 May 2025
Viewed by 583
Abstract
Background: Clarithromycin is a commonly used macrolide antibiotic. Infection is a major source of mortality and morbidity in critical care units. Pharmacokinetics may vary during critical illness and suboptimal antimicrobial exposure has been shown to be associated with treatment failure. The pharmacokinetics of [...] Read more.
Background: Clarithromycin is a commonly used macrolide antibiotic. Infection is a major source of mortality and morbidity in critical care units. Pharmacokinetics may vary during critical illness and suboptimal antimicrobial exposure has been shown to be associated with treatment failure. The pharmacokinetics of intravenous clarithromycin in critical illness have not previously been described. Methods: Pharmacokinetic, clinical and demographic data were collected from critically ill adults receiving intravenous clarithromycin. Drug concentrations were measured using high-performance liquid chromatography/mass spectrometry. Population pharmacokinetic analysis was performed using NONMEM version 7.5.1. Allometric weight scaling was added, and periods of renal replacement therapy were excluded a priori. Simulations of 10,000 patients were performed to assess pharmacokinetic–pharmacodynamic (PKPD) target attainment. Results: The analysis included 121 samples taken from 19 participants. A two-compartment model was found to provide the best fit. The addition of covariates did not improve model fit. There was no evidence of auto-inhibition in this population. Population parameter estimates of clearance and volume of distribution were lower than previously reported, with high interindividual variability. Simulations suggested reasonable pharmacokinetic–pharmacodynamic (PKPD) target attainment with current dosing regimens for most organisms that clarithromycin is used to treat with known clinical breakpoints. Conclusions: To our knowledge, this is the first study to describe the pharmacokinetics of intravenous clarithromycin in humans. Although our simulations suggest reasonable target attainment, further investigation into appropriate PKPD targets and clinical breakpoints for clarithromycin may enable dosing optimisation in this population. Full article
(This article belongs to the Special Issue Antimicrobial Stewardship and Optimizing Antibiotic Dose in Critically Ill Patients)
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14 pages, 2115 KiB  
Article
Pharmacokinetics of Vancomycin in Healthy Korean Volunteers and Monte Carlo Simulations to Explore Optimal Dosage Regimens in Patients with Normal Renal Function
by Yong Kyun Kim, Doy Kim, Gaeun Kang, Dae Young Zang and Dong-Hwan Lee
Antibiotics 2024, 13(10), 993; https://doi.org/10.3390/antibiotics13100993 - 19 Oct 2024
Viewed by 1320
Abstract
Background/Objectives: To date, population pharmacokinetic (PK) studies of vancomycin on healthy Korean adults have not been conducted. This study aimed to investigate the PK properties of vancomycin in healthy volunteers and to identify optimal dosing regimens based on the area under the [...] Read more.
Background/Objectives: To date, population pharmacokinetic (PK) studies of vancomycin on healthy Korean adults have not been conducted. This study aimed to investigate the PK properties of vancomycin in healthy volunteers and to identify optimal dosing regimens based on the area under the concentration–time curve (AUC) in adult patients with normal renal function. Methods: We conducted a prospective clinical study, analysing PK samples from 12 healthy participants using noncompartmental analysis and non-linear mixed-effects modelling. The population PK parameters derived were employed in Monte Carlo simulations to evaluate the adequacy of the current dosing regimen and to formulate dosing recommendations. Results: The PK profiles were optimally described by a two-compartment model, with body weight and age as significant covariates affecting total clearance. The simulations indicated that to achieve a therapeutic target—defined as an AUC at steady-state over 24 h of 400–600 mg·h/L—daily doses ranging from 60 to 70 mg/kg are necessary in adults with normal renal function. Conclusions: This study underscores the need to actively adjust dosage and administration based on a vancomycin PK model that adequately reflects the demographic characteristics of patients to meet both safety and efficacy standards. Full article
(This article belongs to the Special Issue Antimicrobial Stewardship and Optimizing Antibiotic Dose in Critically Ill Patients)
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9 pages, 843 KiB  
Article
Dosing Regimen for Cefotaxime Should Be Adapted to the Stage of Renal Dysfunction in Critically Ill Adult Patients—A Retrospective Study
by Théo Dillies, Sophie Perinel-Ragey, Patricia Correia, Jérôme Morel, Guillaume Thiery and Manon Launay
Antibiotics 2024, 13(4), 313; https://doi.org/10.3390/antibiotics13040313 - 29 Mar 2024
Cited by 1 | Viewed by 2943
Abstract
Cefotaxime administration is recommended in doses of 3–12 g/day in adults with a Glomerular Filtration Rate (GFR) > 5 mL/min. This study aimed to assess the impact of renal function and obesity on cefotaxime concentrations in intensive care unit (ICU) patients. A retrospective [...] Read more.
Cefotaxime administration is recommended in doses of 3–12 g/day in adults with a Glomerular Filtration Rate (GFR) > 5 mL/min. This study aimed to assess the impact of renal function and obesity on cefotaxime concentrations in intensive care unit (ICU) patients. A retrospective cohort study was conducted on consecutive ICU patients receiving continuous cefotaxime infusion between 2020 and 2022 [IRBN992021/CHUSTE]. Doses were not constant; consequently, a concentration-to-dose ratio (C/D) was considered. Statistical analysis was performed to assess the relationship between cefotaxime concentrations, renal function, and obesity. A total of 70 patients, median age 61 years, were included, with no significant difference in cefotaxime concentrations between obese and non-obese patients. However, concentrations varied significantly by GFR, with underdosing prevalent in patients with normal to increased renal function and overdosing in those with severely impaired renal function. Adjustment of cefotaxime dosing according to GFR was associated with improved target attainment. Cefotaxime dosing in critically ill patients should consider renal function, with higher initial doses required in patients with normal to increased GFR and lower doses in those with severely impaired renal function. Therapeutic drug monitoring may aid in optimising dosing regimens. Prospective studies are warranted to validate these findings and inform clinical practice. Full article
(This article belongs to the Special Issue Antimicrobial Stewardship and Optimizing Antibiotic Dose in Critically Ill Patients)
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