Antibiotic dosing in critically ill patients with septic shock and on continuous renal replacement therapy: can we resolve this problem with pharmacokinetic studies and dosing guidelines?

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• 作者：Jason A Roberts (28) (29) (30)
  Darren M Roberts (28)
  
  28. Burns Trauma and Critical Care Research Centre ; School of Medicine ; The University of Queensland ; Level 3 Ned Hanlon Building ; Royal Brisbane and Women鈥檚 Hospital ; Butterfield Street ; Herston ; Queensland ; 4029 ; Australia
  29. Royal Brisbane and Women鈥檚 Hospital ; Butterfield Street ; Herston ; Queensland ; 4029 ; Australia
  30. Department of Molecular and Clinical Pharmacology ; The University of Liverpool ; Ashton Street ; Liverpool ; L69 3GE ; UK
  
• 刊名：Critical Care
• 出版年：2014
• 出版时间：June 2014
• 年：2014
• 卷：18
• 期：3
• 全文大小：134 KB
• 参考文献：1. Ulldemolins, M, Vaquer, S, Llaurado-Serra, M, Pontes, C, Calvo, G, Soy, D, Martin-Loeches, I (2014) Beta lactam dosing in critically ill patient with septic shock and continuous renal replacement therapy. Crit Care 18: pp. 227 CrossRef
  2. Shekar, K, Roberts, JA, Ghassabian, S, Mullany, DV, Wallis, SC, Smith, MT, Fraser, JF (2013) Altered antibiotic pharmacokinetics during extracorporeal membrane oxygenation: cause for concern?. J Antimicrob Chemother 68: pp. 726-727 CrossRef
  3. Udy, AA, Roberts, JA, Boots, RJ, Paterson, DL, Lipman, J (2010) Augmented renal clearance: implications for antibacterial dosing in the critically ill. Clin Pharmacokinet 49: pp. 1-16 CrossRef
  4. Blot, S, Lipman, J, Roberts, DM, Roberts, JA (2014) The influence of acute kidney injury on antimicrobial dosing in critically ill patients: are dose reductions always necessary?. Diagn Microbiol Infect Dis 79: pp. 77-84 CrossRef
  5. Seyler, L, Cotton, F, Taccone, FS, De Backer, D, Macours, P, Vincent, JL, Jacobs, F (2011) Recommended beta-lactam regimens are inadequate in septic patients treated with continuous renal replacement therapy. Crit Care 15: pp. R137 CrossRef
  6. Roberts, DM, Roberts, JA, Roberts, MS, Liu, X, Cole, CL, Nair, P, Lipman, J, Bellomo, R (2012) Variability of antibiotic concentrations in critically ill patients receiving continuous renal replacement therapy 鈥?a multicentre pharmacokinetic study. Crit Care Med 40: pp. 1523-1528 CrossRef
  7. Bagshaw, SM, Uchino, S, Bellomo, R, Morimatsu, H, Morgera, S, Schetz, M, Tan, I, Bouman, C, Macedo, E, Gibney, N, Tolwani, A, Oudemans-van Straaten, HM, Ronco, C, Kellum, JA (2007) Septic acute kidney injury in critically ill patients: clinical characteristics and outcomes. Clin J Am Soc Nephrol 2: pp. 431-439 CrossRef
  8. Wong, G, Briscoe, S, Adnan, S, McWhinney, B, Ungerer, J, Lipman, J, Roberts, JA (2013) Protein binding of beta-lactam antibiotics in critically ill patients: can we successfully predict unbound concentrations?. Antimicrob Agents Chemother 57: pp. 6165-6170 CrossRef
  9. Ulldemolins, M, Roberts, JA, Rello, J, Paterson, DL, Lipman, J (2011) The effects of hypoalbuminaemia on optimising antibiotic dosing in critically ill patients. Clin Pharmacokinet 50: pp. 99-110 CrossRef
  10. Brogard, JM, Jehl, F, Blickle, JF, Dorner, M, Arnaud, JP, Monteil, H (1990) Biliary pharmacokinetic profile of piperacillin: experimental data and evaluation in man. Int J Clin Pharmacol Ther Toxicol 28: pp. 462-470
  11. Jamal, JA, Udy, AA, Lipman, J, Roberts, JA (2014) The impact of variation in renal replacement therapy settings on piperacillin, meropenem, and vancomycin drug clearance in the critically ill: an analysis of published literature and dosing regimens. Crit Care Med.
  12. Choi, G, Gomersall, CD, Tian, Q, Joynt, GM, Freebairn, R, Lipman, J (2009) Principles of antibacterial dosing in continuous renal replacement therapy. Crit Care Med 37: pp. 2268-2282 CrossRef
  13. Sime, FB, Roberts, MS, Peake, SL, Lipman, J, Roberts, JA (2012) Does beta-lactam pharmacokinetic variability in critically ill patients justify therapeutic drug monitoring? A systematic review. Ann Intensive Care 2: pp. 35 CrossRef
  14. Roberts, JA, Hope, WW, Lipman, J (2010) Therapeutic drug monitoring of beta-lactams for critically ill patients: unwarranted or essential?. Int J Antimicrob Agents 35: pp. 419-420 CrossRef
  
• 刊物主题：Intensive / Critical Care Medicine; Emergency Medicine;
• 出版者：BioMed Central
• ISSN：1364-8535

文摘

Dosing antibiotics in critically ill patients to achieve therapeutic concentrations is a significant challenge. The presence of septic shock and prescription of continuous renal replacement therapy introduces further complexities for the clinician. Unfortunately, this is a dilemma encountered daily by intensivists. Although small pharmacokinetic studies are emerging to provide data to help address this problem, the variability in results from these studies is profound. As such, effective antibiotic dosing guidelines for critically ill patients who have septic shock and who receive continuous renal replacement therapy are not available. Dosing flowcharts and therapeutic drug monitoring represent the best available options for clinicians to optimize antibiotic dosing.