Intensive Care Medicine

, Volume 30, Issue 12, pp 2145–2156

Antibiotic pharmacokinetic and pharmacodynamic considerations in critical illness

Review

DOI: 10.1007/s00134-004-2428-9

Cite this article as:
Mehrotra, R., De Gaudio, R. & Palazzo, M. Intensive Care Med (2004) 30: 2145. doi:10.1007/s00134-004-2428-9

Abstract

Background

Many factors over which there may be little control may influence the response of a patient to therapy. However, therapy with antibiotics can be readily optimised.

Discussion

Concentration-dependent agents such as aminoglycosides appear effective and to entail fewer side effects when given in large, infrequent doses. There is also evidence that time-dependent antibiotics often fail to reach adequate concentrations throughout the treatment period. To date no randomised controlled prospective trial has demonstrated improvement in clinical outcome following infusion rather than intermittent boluses of time-dependent antibiotics. Critical illness alters antibiotic pharmacokinetics principally through increases in volume of distribution. Other than glycopeptides and aminoglycosides, antibiotic blood concentrations are rarely monitored and therefore adequate concentrations can only be inferred from clinical response.

Conclusions

Failure to respond within the first few days of empirical treatment may be due to antibiotic resistance or inadequate doses. Therefore the same rigor should be applied to achieving adequate antibiotic concentrations as is applied to inotropes, which are titrated to achieve predetermined physiological targets

Keywords

Antibiotic activity Critical care patients Dose optimasation Pharmacodynamics Pharmacokinetics 

Copyright information

© Springer-Verlag 2004

Authors and Affiliations

  • Rina Mehrotra
    • 1
  • Raffaele De Gaudio
    • 2
  • Mark Palazzo
    • 1
  1. 1.Department Critical Care MedicineCharing Cross HospitalLondonUK
  2. 2.Department of Critical Care, Section of AnaesthesiologyUniversity of FlorenceFlorenceItaly

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