TY - CHAP M1 - Book, Section TI - Principles of Antimicrobial Therapy and the Clinical Pharmacology of Antimicrobial Drugs A1 - Bhalodi, Amira A. A1 - Monogue, Marguerite L. A1 - Nicolau, David P. A2 - Schmidt, Gregory A. A2 - Kress, John P. A2 - Douglas, Ivor S. PY - 2023 T2 - Hall, Schmidt and Wood’s Principles of Critical Care, 5th Edition AB - KEY POINTSThe altered and variable pharmacokinetics of critically ill patients can greatly impact antimicrobial exposures. Recognizing these changes and optimizing antimicrobial administration to make certain appropriate pharmacodynamic targets are reached is crucial in ensuring successful outcomes.Understanding the impact of the minimum inhibitory concentration (MIC) of the pathogen on overall free-drug exposures is important to be able to reach the required pharmacodynamic targets of efficacy. Ultimately, organisms with high MICs will require a larger free-drug exposure compared with organisms with lower MICs.Patients with augmented renal function will exhibit enhanced clearance of antimicrobials, particularly β-lactams, and are at risk for subtherapeutic exposures. Therefore, these patients often require higher doses and more frequent administration of the antimicrobial.Due to the vast degree of pharmacokinetic variability, critically ill patients are likely to benefit from individualized dosing with therapeutic drug monitoring to help ensure efficacy and safety of the antimicrobials they receive.Antimicrobial stewardship focused on disease state management, and selecting the appropriate antimicrobial therapy for the infecting pathogen is essential in preventing poor outcomes. In addition to poor outcomes, failure to treat infections appropriately can lead to the emergence of resistant organisms that become increasingly difficult to treat.Given many antimicrobials are renally cleared, concentrations of antimicrobials are affected by renal replacement therapies, and therefore dosing should be modified accordingly to obtain adequate target exposures. SN - PB - McGraw Hill CY - New York, NY Y2 - 2023/12/10 UR - accessanesthesiology.mhmedical.com/content.aspx?aid=1201804455 ER -