RT Book, Section
A1 Bhalodi, Amira A.
A1 Monogue, Marguerite L.
A1 Nicolau, David P.
A2 Schmidt, Gregory A.
A2 Kress, John P.
A2 Douglas, Ivor S.
SR Print(0)
ID 1201804455
T1 Principles of Antimicrobial Therapy and the Clinical Pharmacology of Antimicrobial Drugs
T2 Hall, Schmidt and Wood’s Principles of Critical Care, 5<sup>th</sup> Edition
YR 2023
FD 2023
PB McGraw Hill
PP New York, NY
SN 9781264264353
LK accessanesthesiology.mhmedical.com/content.aspx?aid=1201804455
RD 2023/11/28
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.