Using pharmacokinetics and pharmacodynamics to optimise dosing of antifungal agents in critically ill patients: a

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

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Mahipal Sinnollareddy1, Sandra L Peake, Michael S Roberts

  • 1Pharmacy Department, The Queen Elizabeth Hospital, 28 Woodville Road, Woodville, Adelaide, SA 5011, Australia. Mahipal.Sinnollareddy@health.sa.gov.au

International Journal of Antimicrobial Agents
|September 20, 2011
PubMed

Insights

Critically ill patients with invasive fungal infections may require adjusted antifungal drug doses. Current dosing may be inappropriate, potentially leading to treatment failure and resistance, necessitating further research.

Area of Science:

  • Critical Care Medicine
  • Infectious Diseases
  • Pharmacology

Background:

  • Invasive fungal infections (IFIs) caused by Candida spp. are rising in critically ill patients.
  • New antifungal agents improve IFI treatment, but pharmacokinetics change in critical illness.
  • Standard dosing may be ineffective or lead to resistance in critically ill patients.

Purpose of the Study:

  • To critically analyze antifungal pharmacokinetics in critically ill patients.
  • To assess the relevance of these pharmacokinetics to clinical dosing requirements.
  • To identify potential needs for dose adjustments in this population.

Main Methods:

  • Systematic review of existing literature.
  • Analysis of pharmacokinetic data of antifungal agents.
  • Evaluation of dosing strategies in critically ill patients.

Main Results:

  • Limited data exist on antifungal pharmacokinetics in critically ill patients.
  • Dosing adjustments may be necessary for some agents in patients with normal or impaired renal function.
  • Current dosing strategies may not achieve optimal pharmacodynamic targets.

Conclusions:

  • Antifungal dosing in critically ill patients may require modification.
  • Further research is essential to validate appropriate dosing and pharmacodynamic targets.
  • Optimized dosing is crucial to improve treatment outcomes and combat antifungal resistance.

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