Clinical pharmacokinetics of antimicrobials in critical care: a narrative review.

IF 4.2 2区 医学 Q1 INFECTIOUS DISEASES Expert Review of Anti-infective Therapy Pub Date : 2024-09-24 DOI:10.1080/14787210.2024.2406466
Ritika Kondel Bhandari, Rachna Rohilla, Nusrat Shafiq, Avaneesh Kumar Pandey, Samir Malhotra
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Abstract

Introduction: The management of critically ill septic patients presents considerable challenges due to multifaceted physiological alterations. Rapid changes such as fluid shifts, hyperdynamic states, and altered renal clearance often require special attention for better clinical outcomes. Vital organ dysfunction, with or without MODS, often necessitates supportive management like RRT, ventilatory support, and ECMO. These interventions can significantly affect the PK/PD of administered antimicrobials, complicating effective treatment.

Area covered: Patient-specific parameters such as age, weight, and comorbid illnesses (e.g. cystic fibrosis, burns, and immunocompromised states) are critical determinants of antimicrobial pharmacokinetics. Understanding PK/PD determinants is crucial for developing optimized dosing regimens that enhance therapeutic efficacy and minimize toxicity in critically ill patients.

Expert opinion: Incorporating pharmacometrics approaches in dose optimization can significantly improve patient outcomes. This review focuses on the nuances of PK/PD for optimized antimicrobial dosing in critically ill septic patients, emphasizing the importance of individualized treatment plans to address the complex and dynamic needs of this patient population. The adoption of these advanced pharmacokinetic and pharmacodynamic principles into clinical practice is essential for advancing patient care and optimizing therapeutic outcomes in critically ill patients.

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重症监护中抗菌药物的临床药代动力学:叙述性综述。
导言:脓毒症重症患者由于多方面的生理变化,其管理面临着相当大的挑战。液体转移、高动力状态和肾清除率改变等快速变化往往需要特别关注,以获得更好的临床效果。无论是否出现 MODS,生命器官功能障碍通常都需要支持性治疗,如 RRT、通气支持和 ECMO。这些干预措施会严重影响抗菌药物的 PK/PD,使有效治疗变得复杂:患者特异性参数,如年龄、体重和合并症(如囊性纤维化、烧伤、免疫功能低下等)是抗菌药物药代动力学的关键决定因素。了解 PK/PD 决定因素对于制定优化的给药方案至关重要,这些方案可提高重症患者的疗效并将毒性降至最低:将药物计量学方法纳入剂量优化可显著改善患者预后。这篇综述重点探讨了 PK/PD 在优化脓毒症重症患者抗菌药物剂量方面的细微差别,强调了个体化治疗方案的重要性,以满足这类患者复杂多变的需求。在临床实践中采用这些先进的药代动力学和药效学原理对于促进患者护理和优化重症患者的治疗效果至关重要。
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来源期刊
CiteScore
11.20
自引率
0.00%
发文量
66
审稿时长
4-8 weeks
期刊介绍: Expert Review of Anti-Infective Therapy (ISSN 1478-7210) provides expert reviews on therapeutics and diagnostics in the treatment of infectious disease. Coverage includes antibiotics, drug resistance, drug therapy, infectious disease medicine, antibacterial, antimicrobial, antifungal and antiviral approaches, and diagnostic tests.
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