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4.2 - Antibiotic Management and Monitoring

from Section 4 - Therapeutic Interventions and Organ Support

Published online by Cambridge University Press:  27 July 2023

By
James McKinlay  and
Alexander Fletcher
Edited by
Ned Gilbert-Kawai ,
Debashish Dutta  and
Carl Waldmann
Ned Gilbert-Kawai
Affiliation:
The Royal Liverpool Hospital
Debashish Dutta
Affiliation:
Princess Alexandra Hospital NHS Trust, Harlow
Carl Waldmann
Affiliation:
Royal Berkshire Hospital, Reading
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Summary

Key Learning Points

  1. 1. Poor anti-microbial stewardship and selection pressure encourage antibiotic resistance.

  2. 2. Pharmacokinetics may be altered significantly and unpredictably by critical illness.

  3. 3. Optimal dosing of antibiotics is difficult. Many patients are likely under-dosed.

  4. 4. Different antibiotics require different approaches to achieving optimal antibiotic exposure.

  5. 5. Therapeutic drug monitoring is standard for aminoglycosides and glycopeptides, but may be helpful for β-lactams, linezolid and some ‘azole’ anti-fungal agents.

Keywords

stewardshipanti-microbialpharmacokineticspharmacodynamicsdose
Type
Chapter
Information
Intensive Care Medicine
The Essential Guide
 , pp. 461 - 466
Publisher: Cambridge University Press
Print publication year: 2021

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References

References and Further Reading

Abdul-Aziz, M, Lipman, J, Mouton, J, Hope, W, Roberts, J. Applying pharmacokinetic/pharmacodynamic principles in critically ill patients: optimizing efficacy and reducing resistance development. Semin Respir Crit Care Med 2015;36:136–53.CrossRefGoogle ScholarPubMed
Cotta, MO, Roberts, JA, Lipman, J. Antibiotic dose optimization in critically ill patients. Med Intensiva 2015;39:563–72.CrossRefGoogle ScholarPubMed
Johnson, I, Banks, V. Antibiotic stewardship in critical care. BJA Education 2017;17:111–16.CrossRefGoogle Scholar
National Institute for Health and Care Excellence. 2015. Antimicrobial stewardship: systems and processes for effective antimicrobial medicine use. www.nice.org.uk/guidance/ng15/chapter/1-RecommendationsGoogle Scholar
Vincent, J-L, Bassetti, M, François, B, et al. Advances in antibiotic therapy in the critically ill. Crit Care 2016;20:133.CrossRefGoogle ScholarPubMed

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