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β‐ L actam pharmacokinetics and pharmacodynamics in critically ill patients and strategies for dose optimization: A structured review
Author(s) -
Sinnollareddy Mahipal G,
Roberts Michael S,
Lipman Jeffrey,
Roberts Jason A
Publication year - 2012
Publication title -
clinical and experimental pharmacology and physiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.752
H-Index - 103
eISSN - 1440-1681
pISSN - 0305-1870
DOI - 10.1111/j.1440-1681.2012.05715.x
Subject(s) - pharmacodynamics , dosing , pharmacokinetics , critically ill , medicine , tolerability , antibiotics , sepsis , intensive care medicine , pharmacology , minimum inhibitory concentration , adverse effect , microbiology and biotechnology , biology
Summary Infections and related sepsis are two of the most prevalent issues in the care of critically ill patients, with mortality as high as 70%. Appropriate antibiotic selection, as well as adequate dosing, is important to improve the clinical outcome for these patients. β‐ L actams are the most common antibiotic class used in critically ill sepsis patients because of their broad spectrum of activity and high tolerability. β‐ L actams exhibit time‐dependent antibacterial activity. Therefore, concentrations need to be maintained above the minimum inhibitory concentration ( MIC ) of pathogenic bacteria. β‐ L actams are hydrophilic antibiotics with small distribution volumes similar to extracellular water and are predominantly excreted through the renal system. Critically ill patients experience a myriad of physiological changes that result in changes in the pharmacokinetics ( PK ) of hydrophilic drugs such as β‐lactams. A different approach to dosing with β‐lactams may increase the likelihood of positive outcomes considering the pharmacodynamics ( PD ) of β‐lactams, as well as the changes in PK in critically ill patients. The present review describes the strategies for dose optimization of β‐lactams in critically ill patients in line with the PK and PD of these drugs.