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Multiplex Therapeutic Drug Monitoring by Isotope-dilution HPLC-MS/MS of Antibiotics in Critical Illnesses

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Published on: August 30, 2018

Antibiotic dosing in critical illness.

Cathrine McKenzie¹

¹Institute of Pharmaceutical Sciences, Kings College London, Franklin-Wilkins Building, Stamford Street, London, UK. catherine.mckenzie@gstt.nhs.uk

The Journal of Antimicrobial Chemotherapy

|March 15, 2011

Summary

Effective antibiotic dosing in critical illness requires understanding drug properties and patient factors. Adjusting doses based on hydrophilic/lipophilic agents, pharmacodynamics, and organ function ensures optimal treatment and patient safety.

Area of Science:

Pharmacology
Critical Care Medicine
Infectious Diseases

Background:

Early and effective antibiotic therapy is crucial for managing critical illness infections.
Antibiotic dosing strategies must account for drug properties and patient-specific factors.

Purpose of the Study:

To outline key considerations for optimizing antibiotic dosing in critically ill patients.
To highlight the impact of drug characteristics and patient organ function on antibiotic efficacy and safety.

Main Methods:

Classification of antibiotics based on physicochemical properties (hydrophilic/lipophilic) and pharmacodynamics (concentration-dependent/time-dependent).
Consideration of patient factors including renal and hepatic function, obesity, and sepsis-induced changes in volume of distribution.

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Published on: January 2, 2017

Review of dosing strategies such as loading doses, extended interval regimens, and continuous infusions.

Main Results:

Hydrophilic antibiotics (e.g., β-lactams) require dose adjustments in sepsis due to increased extravascular space.
Lipophilic antibiotics (e.g., macrolides) are less affected by inflammation but influenced by factors like obesity.
Concentration-dependent antibiotics (e.g., aminoglycosides) benefit from extended interval dosing to maximize efficacy and minimize toxicity.
Time-dependent antibiotics (e.g., β-lactams) require maintaining drug levels above the minimum inhibitory concentration (MIC), ideally via continuous infusion.

Conclusions:

Antibiotic dosing in critical illness is complex, necessitating a tailored approach based on drug properties and individual patient physiology.
Daily review and adjustment of antibiotic therapy are essential to adapt to changes in organ function and pathology, ensuring treatment effectiveness and patient safety.