Antibiotic Therapy in the Critically Ill

  • A. P. R. Wilson


Antibiotics are used in the treatment of more than 80% of patients during their stay in the intensive care unit (ICU) [22], promoting secondary infections with organisms such as Pseudomonas aeruginosa, Candida spp., Enterobacter spp., Acinetobacter spp., enterococci and staphylococci [1]. Consequently, increasing numbers of broad-spectrum agents are being marketed for the treatment of the critically ill patient, for example, the quinolones, monobactams, thienamycins and the newer cephalosporins. To prevent the haphazard introduction of new agents and to limit costs, many hospitals have adopted a restricted list of antibiotics or require approval of certain prescriptions by the microbiology department [66].


Acquire Immune Deficiency Syndrome Antimicrob Agent Fusidic Acid Herpes Simplex Encephalitis Selective Decontamination 
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  1. 1.
    Barrière SL (1985) Cost containment of antimicrobial therapy. Drug Intell Clin Pharm 19: 278–281PubMedGoogle Scholar
  2. 2.
    Bartlett JG (1985) Treatment of Clostridium difficile colitis. Gastroenterology 89: 1192–1195PubMedGoogle Scholar
  3. 3.
    Bean B, Braun C, Balfour HH (1982) Acyclovir therapy for acute herpes zoster. Lancet ii: 118–121Google Scholar
  4. 4.
    Bennett JE, Dismukes WE, Duma RJ et al. (1979) A comparison of amphotericin B alone and combined with flucytosine, in the treatment of cryptococcal meningitis. New Engl J Med 301: 126–131PubMedCrossRefGoogle Scholar
  5. 5.
    Bint AJ, Yeoman P, Kilburn P et al. (1981) The in-vitro activity of ceftazidime compared with that of other cephalosporins. J Antimicrob Chemother 8 [Suppl B]: 47–51PubMedGoogle Scholar
  6. 6.
    Blum MR, Liao SHT, De Miranda (1982) Overview of acyclovir pharmacokinetic disposition in adults and children. Am J Med 73 (1A): 186–192PubMedCrossRefGoogle Scholar
  7. 7.
    Bodem CR, Lampton LM, Miller DF, Tarka DP, Everett ED (1983) Endobronchial pH. Relevance to aminoglycoside activity in Gram-negative bacillary pneumonia. Am Rev Resp Dis 127: 39–41Google Scholar
  8. 8.
    Bryan CS, Stone WJ (1975) Comparably massive penicillin G therapy in renal failure. Ann Intern Med 82: 189–195PubMedGoogle Scholar
  9. 9.
    Bryant LR, Trinkle JK, Moblin-Uddin K et al. (1972) Bacterial colonisation profile with tracheal intubation and mechanical ventilation. Arch Surg 104: 647–651PubMedCrossRefGoogle Scholar
  10. 10.
    Buhles WC, Mastre BJ, Tinker AJ et al. (1988) Ganciclovir treatment of life- or sight-threatening cytomegalovirus infection: experience in 314 immunocompromised patients. Rev Infect Dis 10 [Suppl 3]: S495–S504PubMedCrossRefGoogle Scholar
  11. 11.
    Burke JF (1973) Preventive antibiotic management in surgery. Annu Rev Med 24: 289–294PubMedCrossRefGoogle Scholar
  12. 12.
    Campoli-Richards DM, Monk JP, Price A, Benfield P, Todd PA, Ward A (1988) Ciprofloxacin. A review of its antibacterial activity, pharmacokinetic properties and therapeutic use. Drugs 35: 373–447Google Scholar
  13. 13.
    Clissold SP, Todd PA, Campoli-Richards DM (1987) Imipenem/cilastatin. A review of its antibacterial activity, pharmacokinetic properties and therapeutic efficacy. Drugs 33: 183–241PubMedCrossRefGoogle Scholar
  14. 14.
    Collignon P, Soni N, Pearson I, Sorrell T, Woods P (1988) Sepsis associated with central vein catheters in critically ill patients. Intensive Care Med 14: 227–231PubMedCrossRefGoogle Scholar
  15. 15.
    Cone LA, Woodward DR, Stoltzman DS, Byrd RG (1985) Ceftazidime versus tobramycin-ticarcillin in the treatment of pneumonia and bacteremia. Antimicrob Agents Chemother 28: 33–36PubMedGoogle Scholar
  16. 16.
    Conn IG, Moffat LEF (1988) Short-term cephradine prophylaxis in elective transurethral prostatectomy. J Hosp Infect 11: 373–375PubMedCrossRefGoogle Scholar
  17. 17.
    Craig WA, Kunin CM (1973) Trimethoprimsulfamethoxazole; pharmacodynamic effects of urinary pH and impaired renal function. Ann Intern Med 78: 491–497PubMedGoogle Scholar
  18. 18.
    Crosbie RB (1963) Treatment of staphylococcal infections with “fucidin”. Br Med J i: 788–794Google Scholar
  19. 19.
    Cunha BA, Quintiliani R, Deglin JM et al. (1981) Pharmacokinetics of vancomycin in anuria. Rev Infect Dis 3 [Suppl]: 269–272Google Scholar
  20. 20.
    Currie K, Speller DCE, Simpson RA et al. (1978) A hospital epidemic caused by a gentamicin-resistant Klebsiella aerogenes. J Hyg (Camb) 80: 115–123CrossRefGoogle Scholar
  21. 21.
    Daneshmead TK, Roberts CJC (1984) Impaired elimination of metronidazole in decompensated liver disease. Br Med J 288: 405CrossRefGoogle Scholar
  22. 22.
    Dasta JF (1986) Drug use in a surgical intensive care unit. Drug Intell Clin Pharm 20: 752–756PubMedGoogle Scholar
  23. 23.
    Davies AJ, Dyas A (1984) When should catheter urine specimens be examined? Lancet ii: 982–983Google Scholar
  24. 24.
    de Pauw BE, Kauw F, Muytjens H, Williams KJ, Bothof TH (1983) Randomized study of ceftazidime versus gentamicin plus cefotaxime for infections in severe granulocytopenic patients. J Antimicrob Chemother 12 [Suppl A]: 93–99PubMedGoogle Scholar
  25. 25.
    de Villota E, Algora A, Rubio JJ et al. (1983) Septicaemia in a Medical Intensive Care Unit. Clinical, Biochemical and Microbiological data of 109 Cases. Intensive Care Med 9: 109–115CrossRefGoogle Scholar
  26. 26.
    Editorial (1988) Microbial selective decontamination in intensive care patients. Lancet i: 803–804Google Scholar
  27. 27.
    Eliopoulos GM, Moellering RG (1982) Azlocillin, mezlocillin and piperacillin: new broad spectrum penicillins. Ann Intern Med 97: 755–760PubMedGoogle Scholar
  28. 28.
    Eliopoulos GM, Moellering RG (1982) Antibiotic synergism and antimicrobial combinations in clinical infections. Rev Inf Dis 4: 282–293CrossRefGoogle Scholar
  29. 29.
    EORTC International Antimicrobial Therapy Cooperative Group (1987) Ceftazidime combined with a short or long course of amikacin for empirical therapy of Gram-negative bacteremia in cancer patients with granulocytopenia. N Engl J Med 317: 1692–1698CrossRefGoogle Scholar
  30. 30.
    Eron LJ, Park CH, Hixon DL et al. (1983) Ceftazidime in patients with Pseudomonas infections. J Antimicrob Chemother 12 [Suppl A]: 161–169PubMedGoogle Scholar
  31. 31.
    Eykyn SJ (1984) Infection and intravenous catheters. J Antimicrob Chemother 14: 203–208PubMedCrossRefGoogle Scholar
  32. 32.
    Eykyn S, Jenkins C, King A, Phillips I (1976) Antibacterial activity of cefuroxime, a new cephalosporin antibiotic, compared with that of cephaloridine, cephalothin and cephamandole. Antimicrob Agents Chemother 9: 690–695PubMedGoogle Scholar
  33. 33.
    Eykyn SJ, Gransden WR, Phillips I (1990) The causative organisms of septicaemia and their epidemiology. J Antimicrob Chemother 25: Suppl C, 41–58Google Scholar
  34. 34.
    Feeley TW, Du Moulin GC, Hedley-White J et al. (1975) Aerosol polymyxin and pneumonia in seriously ill patients. N Engl J Med 293: 471–475PubMedCrossRefGoogle Scholar
  35. 35.
    Feldman HA, Hamilton JD, Gutman RA (1973) Amphotericin B therapy in an anephric patient. Antimicrob Agents Chemother 4: 302–305PubMedGoogle Scholar
  36. 36.
    Gasparetto A, Delogu G (1983) Ceftazidime, as a single antibiotic, in the treatment of multi-resistant Gram- negative infections in intensive care. J Antimicrob Chemother 12 [Suppl A]: 171–175PubMedGoogle Scholar
  37. 37.
    Gaya H (1986) In vitro considerations in monotherapy and combination therapy for severe infections. Am J Med 80 (5C): 75–78PubMedGoogle Scholar
  38. 38.
    Gillespie WA (1986) Antibiotics in catheterised patients. J Antimicrob Chemother 12: 149–151CrossRefGoogle Scholar
  39. 39.
    Gingell JC, Waterworth PM (1968) Dose of gentamicin in patients with normal renal function and renal impairment. Br Med J ii: 19–22Google Scholar
  40. 40.
    Gravert C, Schulz E, Sack K (1983) Ceftazidime in intensive care medicine and haemofiltration. J Antimicrob Chemother 12 [Suppl A]: 177–180PubMedGoogle Scholar
  41. 41.
    Hammerman KJ, Sarosi GA, Tosh FE (1974) Amphotericin B in the treatment of saprophytic forms of pulmonary aspergillosis. Am Rev Respir Dis 109: 57–62PubMedGoogle Scholar
  42. 42.
    Hargreave TB, Hindmarsh JR, Elton R et al. (1982) Short term prophylaxis with cefotaxime for prostatic surgery. Br Med J 284: 1008–1010CrossRefGoogle Scholar
  43. 43.
    Hasegawa H, Takahashi K, Imada A, Horiuchi A (1988) Pharmacokinetics of cefotaxime and desacetylcefotaxime in renal failure patients undergoing arteriovenous haemofiltration Drugs 35 [Suppl 2]: 78 — 81PubMedCrossRefGoogle Scholar
  44. 44.
    Hoffler D, Koeppe P, Williams KJ (1983) The pharmacokinetics of ceftazidime in normal and impaired renal function. J Antimicrob Chemother 12 [Suppl A]: 241–245PubMedGoogle Scholar
  45. 45.
    Kaiser AB, Clayson KR, Mulherin JL et al. (1978) Antibiotic prophylaxis in vascular surgery. Ann Surg 188: 283–289PubMedCrossRefGoogle Scholar
  46. 46.
    Keller F, Wagner K, Borner K et al. (1986) Aminoglycoside dosage in hemodialysis patients. J Clin Pharmacol 26: 690–695PubMedGoogle Scholar
  47. 47.
    Kelly WJ, Patrick MR, Hillman KM (1983) Study of diarrhoea in critically ill patients. Crit Care Med 11: 7–9PubMedCrossRefGoogle Scholar
  48. 48.
    Keohane PP, Attrill H, Love M, Frost P, Silk DBA (1984) Relation between osmolality of diet and gastrointestinal side effects in enteral nutrition. Br Med J 288: 678–680CrossRefGoogle Scholar
  49. 49.
    Kerver AJH, Rommes JH, Mevissen-Verhage EAE et al. (1988) Prevention of colonization and infection in critically ill patients: a prospective randomized study. Crit Care Med 16: 1087–1093PubMedCrossRefGoogle Scholar
  50. 50.
    Klastersky J, Glauser MP, Schimpff SC et al. (1986) Prospective randomised comparison of three antibiotic regimens for empirical therapy of suspected bacteremic infection in febrile granulocytopenic patients. Antimicrob Agents Chemother 29: 263–270PubMedGoogle Scholar
  51. 51.
    Koup JR, Lau AH, Brodsky B, Slaughter RL (1979) Chloramphenicol pharmacokinetics in hospitalized patients. Antimicrob Agents Chemother 15: 651–657PubMedGoogle Scholar
  52. 52.
    Kovacs JA, Kovacs AA, Polis M et al. (1985) Cryptococcosis in the acquired immune deficiency syndrome. Ann Intern Med 103: 533–538PubMedGoogle Scholar
  53. 53.
    Ledingham IM, Eastaway AT, McKay IC, Alcock SR, McDonald JC, Ramsay G (1988) Triple regimen of selective decontamination of the digestive tract, systemic cefotaxime, and microbiological surveillance for prevention of acquired infection in intensive care. Lancet i: 785–790Google Scholar
  54. 54.
    Lee HA, Hill LF (1968) The use of ampicillin in renal disease. Br J Clin Pract 22: 354–357PubMedGoogle Scholar
  55. 55.
    Leroy A, Humbert G, Godin M, Filastre JP (1980) Pharmacokinetics of azlocillin in subjects with normal and impaired renal function. Antimicrob Agents Chemother 17: 344–349PubMedGoogle Scholar
  56. 56.
    Lesar TS, Rotschafer JC, Strand LM et al. (1982) Gentamicin dosing errors with four commonly used nomograms. JAMA 248: 1190–1193PubMedCrossRefGoogle Scholar
  57. 57.
    Lewin CS, Allen RA, Amyes SGB (1990) Potential mechanisms of resistance to the modern fluorinated 4-quinolones. J Med Microbiol 31: 153–161PubMedCrossRefGoogle Scholar
  58. 58.
    Louria DB (1981) Clindamycin and other agents in the treatment of lung and pelvic infections. J Antimicrob Chemother 7 [Suppl A]: 37–42PubMedGoogle Scholar
  59. 59.
    Lundbergh P, Jarstrand C, Morfeldt-Manson L, Weiland O (1983) Ceftazidime in septicaemia. J Antimicrob Chemother 12 [Suppl A]: 199–205PubMedGoogle Scholar
  60. 60.
    Macleod SM, Ti TY, Williams RB, Sellers EM (1979) Parenteral 5-fluorocytosine for candidiasis. Drug Intell Clin Pharm 13: 72Google Scholar
  61. 61.
    Maki DG, Goldman DA, Rhame FS (1973) Infection control in intravenous therapy. Ann Intern Med 79: 867–887PubMedGoogle Scholar
  62. 62.
    Mann HJ, Fuhs DW, Cerra FB (1987) Pharmacokinetics and pharmacodynamics in critically ill patients. World J Surg 11: 210–217PubMedCrossRefGoogle Scholar
  63. 63.
    Matthew M (1979) Plasmid-mediated beta lactamases of Gram-negative bacteria: properties and distribution. J Antimicrob Chemother 5: 349–358PubMedCrossRefGoogle Scholar
  64. 64.
    Matzke GR, McGory RW, Halstenson CE, Keane WF (1984) Pharmacokinetics of vancomycin in patients with various degrees of renal function. Antimicrob Agents Chemother 25: 433–437PubMedGoogle Scholar
  65. 65.
    Matzke GR, Halstenson CE, Keane WF (1984) Hemodialysis elimination rates and clearance of gentamicin and tobramycin. Antimicrob Agents Chemother 25: 128–130PubMedGoogle Scholar
  66. 66.
    McGowan JE, Finland M (1974) Usage of antibiotics in a general hospital: the effect of requiring justification. J Infect Dis 130: 165–168PubMedCrossRefGoogle Scholar
  67. 67.
    McGowan JE, Parrot PL, Duty VP (1977) Nosocomial bacteremia. Potential for prevention of procedure related cases. JAMA 237: 2727–2729Google Scholar
  68. 68.
    Meyer RD (1983) Legionella infections: a review of five years of research. Rev Infect Dis 5: 258–278PubMedCrossRefGoogle Scholar
  69. 69.
    Michie HR, Wilmore DW (1990) Sepsis, signals and surgical sequelae (a hypothesis). Arch Surg 125:531– 536PubMedCrossRefGoogle Scholar
  70. 70.
    Mitchell CD, Bean B, Gentry SR et al. (1981) Acyclovir therapy for mucocutaneous Herpes simplex infections in immunocompromised patients. Lancet i: 1389–1392CrossRefGoogle Scholar
  71. 71.
    Mock CN, Burchard KW, Hasan F, Reed M (1988) Surgical intensive care unit pneumonia. Surgery 104: 494–499PubMedGoogle Scholar
  72. 72.
    Moore RD, Smith CR, Lietman PS (1984) The association of aminoglycoside plasma levels with mortality in patients with gram negative bacteremia. J Infect Dis 149: 443–448PubMedCrossRefGoogle Scholar
  73. 73.
    Pancorbo S, Comty C (1981) Pharmacokinetics of gentamicin in patients undergoing continuous ambulatory peritoneal dialysis. Antimicrob Agents Chemother 19: 605–607PubMedGoogle Scholar
  74. 74.
    Park GR, Drummond GB, Lamb D et al. (1982) Disseminated aspergillosis occurring in patients with respiratory, renal and hepatic failure. Lancet ii: 179 — 183Google Scholar
  75. 75.
    Penketh ARL, Wansbrough-Jones MH, Wright E et al. (1985) Antibiotic prophylaxis for coronary artery bypass graft surgery. Lancet i: 1500CrossRefGoogle Scholar
  76. 76.
    Pennington JE (1981) Penetration of antibiotics into respiratory secretions. Rev Inf Dis 3: 67–73CrossRefGoogle Scholar
  77. 77.
    Pennington JE (1988) Recent advances in the treatment of pneumonia in the intensive care unit. J Hosp Infect 11 [Suppl A]: 295–302PubMedCrossRefGoogle Scholar
  78. 78.
    Peters G (1988) New considerations in the pathogenesis of coagulase-negative staphylococcal foreign body infections. J Antimicrob Chemother 21 [Suppl C]: 139–148PubMedGoogle Scholar
  79. 79.
    Quercia RA, Hills SW, Klimek JJ et al. (1986) Bacteriological contamination of intravenous delivery systems in an intensive care unit. Am J Med 80:364– 368PubMedCrossRefGoogle Scholar
  80. 80.
    Richardson JF and Marples RR (1982) Changing resistance to antimicrobial drugs, and resistance typing in clinically significant strains of Staphylococcus epidermidis. J Med Microbiol 15: 475–484PubMedCrossRefGoogle Scholar
  81. 81.
    Richardson JF, Marples RR, de Saxe MJ (1984) Characters of coagulase negative staphylococci and micrococci from cases of endocarditis. J Hosp Infect 5: 164–171PubMedCrossRefGoogle Scholar
  82. 82.
    Ruddell WSJ, Losowsky MS (1980) Severe diarrhoea due to small intestinal colonization during Cimetidine treatment. Br Med J 281: 273PubMedCrossRefGoogle Scholar
  83. 83.
    Ruiz-Santana S, Jimenez AC, Esteban A et al. (1987) ICU pneumonias: a multi-institutional study. Crit Care Med 15: 930–932PubMedCrossRefGoogle Scholar
  84. 84.
    Sarosi GA, Armstrong D, Barbee RA et al. (1979) Treatment of fungal diseases. Am Rev Resp Dis 120: 1393–1397Google Scholar
  85. 85.
    Shapiro M, Wald U, Simchem E et al. (1986) Randomized clinical trial of intra-operative antimicrobial prophylaxis of infection after neurosurgical procedures. J Hosp Infect 8: 283–295PubMedCrossRefGoogle Scholar
  86. 86.
    Somogyi AA, Kong CB, Gurr FW et al. (1984) Metronidazole pharmacokinetics in patients with acute renal failure. J Antimicrob Chemother 13: 183–189PubMedCrossRefGoogle Scholar
  87. 87.
    Smith AL, Weber A (1983) Pharmacology of chloramphenicol. Pediatr Clin North Am 30: 209–236PubMedGoogle Scholar
  88. 88.
    Stoddart JC, Airey IL, Al-Jumaili IJ, Bint AJ (1982) Pseudomonas aeruginosa in the intensive care unit. Intensive Care Med 8: 279–282PubMedCrossRefGoogle Scholar
  89. 89.
    Stoutenbeek CP, van Saene HKF, Miranda DR, Zandstra DF, Langrehr D (1986) Nosocomial gram- negative pneumonia in critically ill patients. Intensive Care Med 12: 419–423PubMedCrossRefGoogle Scholar
  90. 90.
    Stoutenbeek CP, van Saene HKF, Zandstra DF (1987) The effect of oral non-absorbable antibiotics on the emergence of resistant bacteria in patients in an intensive therapy unit. J Antimicrob Chemother 19: 513–520PubMedCrossRefGoogle Scholar
  91. 91.
    Tosolini FA, Dawborn JK, Fensling B et al. (1985) Clinical, microbiological and pharmacokinetic assessment of piperacillin sodium. Curr Ther Res 37: 9–22Google Scholar
  92. 92.
    Unertl KE, Lenhart FP, Ruckdeschel G (1990) Selective gut decontamination in ventilated patients. In: Vincent JL (ed) Update in intensive care and emergency Medicine 10. Springer, Berlin Heidelberg New York, pp 32–39Google Scholar
  93. 93.
    Van Dalen R, Vree TB, Hafkenscheild JCM, Gimbrere JSF (1979) Determination of plasma and renal clearance of cefuroxime and its pharmacokinetics in renal insufficiency. J Antimicrob Chemother 5: 281–292PubMedCrossRefGoogle Scholar
  94. 94.
    Warren RE, Roberts SOB (1976) Gentamicin-resistant staphylococci. Lancet i: 543–544Google Scholar
  95. 95.
    Welling PG, Craig WA, Bundtzen RW et al. (1983) Pharmacokinetics of piperacillin in subjects with varying degrees of renal function. Antimicrob Agents Chemother 23: 881–887PubMedGoogle Scholar
  96. 96.
    Wharton JM, Coleman DL, Wofsy CB et al. (1986) Trimethoprim-sulfamethoxazole or pentamidine for Pneumocystis carinii pneumonia in the acquired immunodeficiency syndrome. Ann Intern Med 105: 37–44PubMedGoogle Scholar
  97. 97.
    Whitley RJ, Alford CA, Hirsch MS et al. (1986) Vidarabine versus acyclovir therapy in Herpes simplex encephalitis. N Engl J Med 314: 144–149PubMedCrossRefGoogle Scholar
  98. 98.
    Williams RL (1983) Drug administration in hepatic disease. N Engl J Med 309: 1616–1622PubMedCrossRefGoogle Scholar
  99. 99.
    Wilson APR, Treasure T, Sturridge MF, Grüneberg RN (1986) Antibiotic prophylaxis in cardiothoracic surgery in the United Kingdom: current practice. Thorax 41: 396–400PubMedCrossRefGoogle Scholar
  100. 100.
    Wilson APR, Treasure T, Grüneberg RN et al. (1988) Antibiotic prophylaxis in cardiac surgery: a prospective comparison of two dosage regimens of teicoplanin with a combination of flucloxacillin and tobramycin. J Antimicrob Chemother 21: 213–224PubMedCrossRefGoogle Scholar
  101. 101.
    Winston DJ, Lau WK, Gale RP, Young LS (1980) Trimethoprim/sulfamethoxazole for the treatment of Pneumocystis carinii pneumonia. Ann Intern Med 92: 762–769PubMedGoogle Scholar

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