Antibiotics in critical care: Dosing, therapeutic drug monitoring and continuous infusions

Critically ill patients are particularly vulnerable to develop infections and these infections may be caused by pathogens with reduced susceptibility to currently available antibiotics. Rapid, adequate and appropriate individualised antibiotic therapy can help improve outcomes in these patients, and in this chapter we discuss how to optimise this treatment. In order to deliver this kind of therapy, rapid and accurate diagnosis of infection and identification of infecting pathogens and their antibiotic susceptibilities is necessary. This may be facilitated by using new technologies such as MALDI-TOF (matrix-assisted laser desorption ionisation time-of-flight) mass spectrometry and PCR techniques. As the pharmacokinetics of drugs is unpredictable in infected, critically ill patients, routine therapeutic drug monitoring of antibiotics should be considered whenever possible to optimise therapeutic efficacy and reduce risk of toxicity. In order to improve therapeutic efficacy, antibiotics may be given with higher loading doses, in continuous perfusion or by inhalation.SCOPUS: ar.j