Antibióticos en UCI/ICU antibiotics

Farmacocinética plasmática de antimicrobianos en pacientes críticamente enfermos


Plasma Pharmacokinetics of Antimicrobial Agents in Critically Ill Patients
Federico Pea*
Current Clinical Pharmacology, 2013, 8, 5-12 5
Abstract:
Prompt optimal antimicrobial treatment in critically ill patients is mandatory and must be achieved not only in terms of spectrum of activity, but also in terms of exposure at the infection site. Plasma profile of antimicrobial agents may represent a valid surrogate marker of drug exposure and allow to identify the correct dosage for a given drug. However, in the critically ill patients the pharmacokinetic behavior of antimicrobials may be altered by some very peculiar pathophysiological conditions, so that dosages significantly different from those used in clinically stable patients or from those originally studied in healthy volunteers for regulatory purposes may often be needed in order to ensure optimal plasma drug exposure in such population. This is especially true for hydrophilic antimicrobials (aminoglycosides, betalactams, glycopeptides, lipopeptides, echinocandins, fluconazole, acyclovir, ganciclovir) whose volume of distribution and clearance may be significantly altered by these conditions. These aspects are particularly relevant in patients with severe sepsis or with septic shock for whom the time for being considered as a special population to be studied apart from the general population has probably come. From the healthcare system perspective, this means that individualization of antimicrobial therapy by means of a real time therapeutic drug monitoring coupled with clinical pharmacological advice should be considered an invaluable tool for optimizing antimicrobial therapy and for the containment of microbial resistance in this setting.
Keywords:
Augmented renal clearance, loading dose, maintenance dose, sepsis, Hydrophilic Antimicrobials, Lipophilic Antimicrobials, diet in renal disease, therapeutic drug, tigecycline, azithromycin
http://www.eurekaselect.com/106036/article




Resistencia a antibióticos en pacientes con sepsis: Evaluación y recomendaciones del uso de antibióticos

Antibiotic resistance in sepsis patients: Evaluation and recommendation of antibiotic use.
Pradipta IS, Sodik DC, Lestari K, Parwati I, Halimah E, Diantini A, Abdulah R.
North Am J Med Sci [serial online] 2013 [cited 2013 Jun 28];5:344-52.
Abstract
Background: The appropriate selection of empirical antibiotics based on the pattern of local antibiotic resistance can reduce the mortality rate and increase the rational use of antibiotics. Aims: We analyze the pattern of antibiotic use and the sensitivity patterns of antibiotics to support the rational use of antibiotics in patients with sepsis. Materials and Methods: A retrospective observational study was conducted in adult sepsis patient at one of Indonesian hospital during January-December 2011. Data were collected from the hospital medical record department. Descriptive analysis was used in the processing and interpretation of data. Results: A total of 76 patients were included as research subjects. Lung infection was the highest source of infection. In the 66.3% of clinical specimens that were culture positive for microbes, Klebsiella pneumoniae, Escherichia coli, Staphylococcus hominis were detected with the highest frequency. The six most frequently used antibiotics, levofloxacin, ceftazidime, ciprofloxacin, cefotaxime, ceftriaxone, and erythromycin, showed an average resistance above 50%. Conclusions: The high use of antibiotic with a high level resistance requires a policy to support its rational use. Local microbial pattern based on site infection and pattern of antibiotics sensitivity test can be used as supporting data to optimize appropriateness of empirical antibiotics therapy in sepsis patients.
Keywords: Antibiotic resistance, Bacteremia, Sepsis, Systemic infection
http://www.najms.org/text.asp?2013/5/6/344/114165



Más sobre antibióticos en UCI
Current Clinical Pharmacology VOLUME: 8 ISSUE: 1; 2013
http://www.eurekaselect.com/106032/issue/1




Atentamente
Dr. Juan C. Flores-Carrillo
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org