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Medical management of tuberculosis (TB) patients involves a comprehensive approach that includes diagnosis, treatment, and monitoring. The specific strategies can vary depending on the type of tuberculosis (latent or active), the patient's overall health status, and other considerations.
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Circadian rhythms are cyclic changes that are crucial in plasma drug concentrations. Various standard circadian parameters, including core body temperature, heart rate, and other cardiovascular factors, directly impact disease states and the therapeutic response to drug therapy.
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Multiplex Therapeutic Drug Monitoring by Isotope-dilution HPLC-MS/MS of Antibiotics in Critical Illnesses
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When to Stop Antibiotics in the Critically Ill?

Nathan D Nielsen1,2, James T Dean1, Elizabeth A Shald3

  • 1Division of Pulmonary, Critical Care and Sleep Medicine, University of New Mexico School of Medicine, Albuquerque, NM 87131, USA.

Antibiotics (Basel, Switzerland)
|March 27, 2024
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Summary

Antibiotic stewardship is crucial for critically ill patients to minimize risks like antimicrobial resistance (AMR). A multi-modal approach using biomarkers and interdisciplinary teams can guide appropriate antibiotic duration.

Keywords:
antibioticsantimicrobial resistancebiomarkersclinical responseduration of therapyfixed duration

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Area of Science:

  • Critical Care Medicine
  • Infectious Diseases
  • Pharmacology

Background:

  • Antibiotic use has significantly increased in critically ill patients over the last century.
  • Concerns are rising regarding appropriate antibiotic treatment guidelines and durations.
  • Antibiotic administration carries short-term (hepatic/renal dysfunction), intermediate (superinfections), and long-term (antimicrobial resistance) risks, exacerbated by prolonged or broad-spectrum use.

Purpose of the Study:

  • To review strategies for determining appropriate antimicrobial therapy duration.
  • To highlight the clinical shift towards multi-modal approaches for optimizing antibiotic cessation.
  • To propose an integrated approach for informed clinical decision-making in antibiotic treatment.

Main Methods:

  • Literature review focusing on strategies for antimicrobial therapy duration.
  • Analysis of the clinical trend towards multi-modal decision-making for antibiotic courses.
  • Conceptualization of an approach integrating biomarker assays and interdisciplinary teams.

Main Results:

  • Increasing focus on strategies to determine optimal antimicrobial therapy duration.
  • Emerging clinical trend towards multi-modal strategies for antibiotic cessation.
  • Identification of biomarker assays and interdisciplinary collaboration as key components for future decision-making.

Conclusions:

  • Optimizing antibiotic duration is essential to mitigate treatment risks and combat antimicrobial resistance (AMR).
  • A multi-modal approach, combining biomarker data with interdisciplinary team input (pharmacists, nurses, physicians, microbiologists), represents a promising strategy for evidence-based clinical decision-making in antibiotic therapy.