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Updated: Oct 16, 2025
Multiplex Therapeutic Drug Monitoring by Isotope-dilution HPLC-MS/MS of Antibiotics in Critical Illnesses
Published on: August 30, 2018
[Antibiotics therapy in critically ill patients: the other side of the coin]
1Department of Anaesthesiology, Resuscitation and Intensive Care, Faculty Hospital Ostrava, Czech Republic,
Abstract:
The aim of this mini-review is to draw attention to the risk aspects associated with antibiotic treatment in critically ill patients. These include antibiotic underdosing in the early phase of sepsis if treatment is governed by pharmacopoeia and unnecessarily long exposure to antibiotics if treatment is guided by traditional recommendations for the length of antibiotic administration. The need for discussing the loading dose of antibiotics and routine monitoring of serum antibiotic concentrations during treatment is stated. Antibiotic-induced mitochondrial dysfunction and oxidative stress are also discussed. Indeed, both of these mechanisms, otherwise effective in inhibiting the growth of tumor cells, may play an important role in the prolonged course of multiorgan failure if antibiotic treatment is too long.
Insights
Antibiotic dosing in critically ill patients requires careful consideration to avoid underdosing during sepsis and prolonged exposure. Monitoring serum concentrations and understanding drug-induced mitochondrial dysfunction are crucial for effective treatment.
Area of Science:
- Critical Care Medicine
- Pharmacology
- Infectious Diseases
Background:
- Antibiotic therapy is essential for critically ill patients but carries significant risks.
- Current dosing strategies may lead to suboptimal antibiotic exposure.
- Long-term antibiotic use can have detrimental effects.
Purpose of the Study:
- To highlight the risks of antibiotic treatment in critically ill patients.
- To discuss optimal antibiotic dosing and administration strategies.
- To review the impact of antibiotic-induced mitochondrial dysfunction.
Main Methods:
- This mini-review synthesizes existing literature on antibiotic pharmacokinetics and pharmacodynamics in critically ill patients.
- It discusses the implications of traditional dosing guidelines versus individualized approaches.
- Mechanisms of antibiotic-induced toxicity are examined.
Main Results:
- Antibiotic underdosing can occur in early sepsis if relying solely on standard pharmacopoeia.
- Prolonged antibiotic exposure, guided by traditional duration recommendations, may be detrimental.
- Antibiotic-induced mitochondrial dysfunction and oxidative stress can contribute to multiorgan failure.
Conclusions:
- Individualized antibiotic dosing, including loading doses and serum concentration monitoring, is essential.
- The duration of antibiotic therapy should be carefully considered to minimize toxicity.
- Understanding antibiotic-induced cellular mechanisms is key to improving patient outcomes.
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