Optimizing dosing of antibiotics in critically ill patients.

Abstract:

PURPOSE OF REVIEW:Recent studies suggest that contemporary antibiotic dosing is unlikely to achieve best outcomes for critically ill patients because of extensive pharmacokinetic variability and altered pharmacodynamics. Dose adaptation is considered quite challenging because of unpredictable dose-exposure relationships. Consequently, individualization of antibiotic dosing has been advocated. Herein, we describe recent developments in the optimization of antibiotic dosing in the critically ill. RECENT FINDINGS:Conventional doses of many antibiotics frequently result in sub or supratherapeutic exposures in the critically ill. Clinical studies continue to illustrate that dose-exposure relationships are highly variable in severely ill patients. Dose optimization based on pharmacokinetic/pharmacodynamic principles can effectively improve antibiotic exposure. Therapeutic drug monitoring (TDM) with adaptive feedback is likely to be the most robust approach to optimize dosing for individual patients. This more accurate approach to dosing is made possible with the user-friendly dosing software that is emerging. SUMMARY:The scope of TDM is broadening from the traditional focus on prevention of toxicity, to include optimization of antibiotic exposure thereby improving patient outcomes. However, the evidence relating TDM practice with improved clinical outcome remains limited. Well designed, multicentre, randomized controlled studies are warranted.

journal_name

Curr Opin Infect Dis

authors

Parker SL,Sime FB,Roberts JA

doi

10.1097/QCO.0000000000000206

subject

Has Abstract

pub_date

2015-12-01 00:00:00

pages

497-504

issue

6

eissn

0951-7375

issn

1473-6527

journal_volume

28

pub_type

杂志文章,评审
  • Chagas disease in the immunosuppressed host.

    abstract:PURPOSE OF REVIEW:This review examines recent literature on Chagas disease in the immunosuppressed host. RECENT FINDINGS:Chagas disease in immunosuppressed patients may represent acute transmission in an organ recipient, or reactivation of chronic infection in an HIV-infected individual or patient receiving cardiac tr...

    journal_title:Current opinion in infectious diseases

    pub_type: 杂志文章,评审

    doi:10.1097/QCO.0b013e328354f179

    authors: Bern C

    更新日期:2012-08-01 00:00:00

  • The role of surveillance cultures in guiding ventilator-associated pneumonia therapy.

    abstract:PURPOSE OF REVIEW:Ventilator-associated pneumonia (VAP) is the most frequent cause of death among the nosocomial infections acquired in the ICU. Routine surveillance endotracheal aspirate (ETA) cultures in patients on mechanical ventilation have been proposed to predict the cause of VAP. Our aim is to review the availa...

    journal_title:Current opinion in infectious diseases

    pub_type: 杂志文章,评审

    doi:10.1097/QCO.0000000000000042

    authors: Luna CM,Bledel I,Raimondi A

    更新日期:2014-04-01 00:00:00

  • Host determinants of antiretroviral drug activity.

    abstract:PURPOSE OF REVIEW:As physicians are confronted with a diversity of adverse events and variability in response to medication among patients, this review will focus on the available evidence regarding the impact of genetic variation on drug response. Specifically, variation in drug metabolizing enzymes such as the cytoch...

    journal_title:Current opinion in infectious diseases

    pub_type: 杂志文章,评审

    doi:10.1097/01.qco.0000191507.48481.10

    authors: Boffito M,Winston A,Owen A

    更新日期:2005-12-01 00:00:00

  • New advances in Clostridium difficile infection: changing epidemiology, diagnosis, treatment and control.

    abstract:PURPOSE OF REVIEW:Clostridium difficile infection and Clostridium difficile-associated diarrhea (CDAD) are growing worldwide health threats. Recent studies have identified new host risk factors, diagnostic approaches and therapies of CDAD. The present review focuses on scientific papers published in the past 18 months ...

    journal_title:Current opinion in infectious diseases

    pub_type: 杂志文章,评审

    doi:10.1097/QCO.0b013e32830f9397

    authors: DuPont HL,Garey K,Caeiro JP,Jiang ZD

    更新日期:2008-10-01 00:00:00

  • Parasitic infections of the intestine.

    abstract::Intestinal protozoal infections cause significant disease not only in the tropics but also in immunocompromised hosts and returning travellers in the developed world. Precise diagnosis of protozoal intestinal infection by microscopy can be difficult. Enzyme immunoassays for antigen detection are being used for some pr...

    journal_title:Current opinion in infectious diseases

    pub_type: 杂志文章,评审

    doi:10.1097/00001432-200110000-00013

    authors: Schuster H,Chiodini PL

    更新日期:2001-10-01 00:00:00

  • New interleukins: are there any more?

    abstract:PURPOSE OF REVIEW:It is now well established that cytokines play a critical role in the regulation of the immune system. Processes such as lymphoid development, differentiation, homeostasis, tolerance and memory are all regulated by cytokines that bind the type I family of cytokine receptors. Like the interferons, whic...

    journal_title:Current opinion in infectious diseases

    pub_type: 杂志文章,评审

    doi:10.1097/00001432-200306000-00005

    authors: Gadina M,Ferguson PR,Johnston JA

    更新日期:2003-06-01 00:00:00

  • Mosquito stage, transmission blocking vaccines for malaria.

    abstract:PURPOSE OF REVIEW:This review highlights progress made in the development of vaccines aimed at the stages of malaria parasites found in mosquitoes that block the transmission of malaria within a community. RECENT FINDINGS:Substantial progress has been made on the production and characterization of the leading candidat...

    journal_title:Current opinion in infectious diseases

    pub_type: 杂志文章,评审

    doi:10.1097/QCO.0b013e3282a95e12

    authors: Saul A

    更新日期:2007-10-01 00:00:00

  • Hepatitis C virus treatment as prevention in people who inject drugs: testing the evidence.

    abstract:PURPOSE OF REVIEW:The majority of hepatitis C virus (HCV) infections in the United Kingdom and many developing countries were acquired through injecting. New clinical guidance suggests that HCV treatment should be offered to people with a transmission risk - such as people who inject drugs (PWID) - irrespective of seve...

    journal_title:Current opinion in infectious diseases

    pub_type: 杂志文章,评审

    doi:10.1097/QCO.0000000000000216

    authors: Hickman M,De Angelis D,Vickerman P,Hutchinson S,Martin NK

    更新日期:2015-12-01 00:00:00

  • HIV and diarrhoea: what is new?

    abstract:PURPOSE OF REVIEW:The review examines the changing causes and the investigation of infectious and noninfectious diarrhoea in individuals with HIV. RECENT FINDINGS:Despite the excellent prognosis conferred by combination antiretroviral therapy, diarrhoea is still common in HIV-positive individuals and is associated wit...

    journal_title:Current opinion in infectious diseases

    pub_type: 杂志文章,评审

    doi:10.1097/QCO.0000000000000305

    authors: Logan C,Beadsworth MB,Beeching NJ

    更新日期:2016-10-01 00:00:00

  • Outbreaks of nontuberculous mycobacteria.

    abstract:PURPOSE OF REVIEW:The purpose of this review is to summarize the emerging literature on nontuberculous mycobacteria outbreaks in healthcare settings. As our ability to identify mycobacterial species develops, we are better able to recognize epidemiologic connections and better understand the prevalence and importance o...

    journal_title:Current opinion in infectious diseases

    pub_type: 杂志文章,评审

    doi:10.1097/QCO.0000000000000386

    authors: Sood G,Parrish N

    更新日期:2017-08-01 00:00:00

  • Infection control in countries with limited resources.

    abstract::Considerable progress has been made in the development of effective hospital infection control programs in countries with limited resources, most notably in Asia and Latin America. National nosocomial infection surveillance methods are now used in a variety of countries, particularly in Brazil, and offer a better meas...

    journal_title:Current opinion in infectious diseases

    pub_type: 杂志文章

    doi:10.1097/00001432-199808000-00010

    authors: Huskins WC,Soule B

    更新日期:1998-08-01 00:00:00

  • Pathogenesis of the immune reconstitution inflammatory syndrome in HIV-infected patients.

    abstract:PURPOSE OF REVIEW:The immune reconstitution inflammatory syndrome (IRIS) is an important clinical complication in HIV-infected patients initiating antiretroviral therapy. This review focuses on the latest literature pertaining to the pathogenesis of IRIS. RECENT FINDINGS:The clinical manifestations of IRIS are heterog...

    journal_title:Current opinion in infectious diseases

    pub_type: 杂志文章,评审

    doi:10.1097/QCO.0b013e328352b664

    authors: Martin-Blondel G,Mars LT,Liblau RS

    更新日期:2012-06-01 00:00:00

  • Malaria.

    abstract:PURPOSE OF REVIEW:This review addresses recent developments that relate to the pathogenesis of severe malaria and its treatment, and also highlights the increase in the global burden of malaria and provides a summary of clinical trials of malaria vaccines. RECENT FINDINGS:Malaria, one of the world's most important par...

    journal_title:Current opinion in infectious diseases

    pub_type: 杂志文章,评审

    doi:10.1097/00001432-200310000-00004

    authors: Maitland K,Bejon P,Newton CR

    更新日期:2003-10-01 00:00:00

  • The HIV epidemic in Italy.

    abstract::The implementation of surveillance systems for HIV and of large cohort studies have allowed for the construction of models that more accurately describe the HIV epidemic. This review focuses on changes in the epidemiological pattern, and the effect of changes in behaviour and of antiretroviral therapy. ...

    journal_title:Current opinion in infectious diseases

    pub_type: 杂志文章

    doi:10.1097/00001432-199802000-00004

    authors: Greco D

    更新日期:1998-02-01 00:00:00

  • What role do viruses play in nosocomial pneumonia?

    abstract:PURPOSE OF THE REVIEW:Viruses are an increasingly recognized cause of community-acquired pneumonia (CAP), but their exact role in nosocomial pneumonia is still debated. This review focuses on the role of viruses as a cause of nosocomial pneumonia. RECENT FINDINGS:Respiratory viruses may be responsible for healthcare-a...

    journal_title:Current opinion in infectious diseases

    pub_type: 杂志文章,评审

    doi:10.1097/QCO.0000000000000049

    authors: Luyt CE,Bréchot N,Chastre J

    更新日期:2014-04-01 00:00:00

  • Postexposure prophylaxis after sexual exposure to HIV.

    abstract:PURPOSE OF REVIEW:HIV postexposure prophylaxis is often recommended following potential sexual exposure to HIV. Recent data address the effectiveness of postexposure prophylaxis and prevention counseling, cost-effectiveness, antiretroviral options, challenges with nonoccupational postexposure prophylaxis among adolesce...

    journal_title:Current opinion in infectious diseases

    pub_type: 杂志文章,评审

    doi:10.1097/QCO.0b013e328012c5e0

    authors: Roland ME

    更新日期:2007-02-01 00:00:00

  • Preemptive antifungal therapy: still a way to go.

    abstract:PURPOSE OF REVIEW:Early treatment of invasive mold infections improves the outcome. Therapy is often delayed, however, because available diagnostic tools such as culture, microscopy and conventional radiology lack sensitivity; consequently, empirical initiation of antifungal therapy has been advocated, particularly for...

    journal_title:Current opinion in infectious diseases

    pub_type: 杂志文章,评审

    doi:10.1097/QCO.0b013e3280106854

    authors: Maertens J,Deeren D,Dierickx D,Theunissen K

    更新日期:2006-12-01 00:00:00

  • Immune responses in hepatitis C: is virus or host the problem?

    abstract:PURPOSE OF REVIEW:Hepatitis C virus is an RNA virus that usually establishes persistent infection in its host. As an important cause of cirrhosis and hepatocellular carcinoma worldwide, hepatitis C is a growing public health concern. Despite recent advances in therapy, most people infected with the virus can expect lif...

    journal_title:Current opinion in infectious diseases

    pub_type: 杂志文章,评审

    doi:10.1097/00001432-200406000-00004

    authors: Darling JM,Wright TL

    更新日期:2004-06-01 00:00:00

  • Effect of major abdominal surgery on the host immune response to infection.

    abstract:PURPOSE OF REVIEW:The present review summarizes key studies on the effects of major abdominal surgery on the host response to infection published during the last 18 months. RECENT FINDINGS:Surgical trauma causes stereotyped systemic proinflammatory and compensatory anti-inflammatory reactions. It is leukocyte reprogra...

    journal_title:Current opinion in infectious diseases

    pub_type: 杂志文章,评审

    doi:10.1097/QCO.0b013e32833939cb

    authors: Buttenschoen K,Fathimani K,Buttenschoen DC

    更新日期:2010-06-01 00:00:00

  • New approaches to prevention of staphylococcal infection in surgery.

    abstract:PURPOSE OF REVIEW:The present review describes the literature about the prevention of Staphylococcus aureus infections in surgery, published from August 2006 to January 2008, and puts it into perspective. RECENT FINDINGS:To prevent Staphylococcus aureus infections after surgical procedures, three methods were describe...

    journal_title:Current opinion in infectious diseases

    pub_type: 杂志文章,评审

    doi:10.1097/QCO.0b013e328301391d

    authors: van Rijen MM,Kluytmans JA

    更新日期:2008-08-01 00:00:00

  • Update on treatment of cytomegalovirus infection in pregnancy and of the newborn with congenital cytomegalovirus.

    abstract:PURPOSE OF REVIEW:The purpose of this review is to assess the recent studies of therapy of pregnant women and neonates, aimed at preventing the consequences of congenital cytomegalovirus (CMV) infection. RECENT FINDINGS:A recent randomized controlled trial of treatment of CMV during pregnancy with hyperimmune globulin...

    journal_title:Current opinion in infectious diseases

    pub_type: 杂志文章,评审

    doi:10.1097/QCO.0000000000000317

    authors: Rawlinson WD,Hamilton ST,van Zuylen WJ

    更新日期:2016-12-01 00:00:00

  • Impact of diagnostic markers on early antifungal therapy.

    abstract:PURPOSE OF REVIEW:The early treatment of invasive fungal infection is critical but is hampered by the non-specific nature of clinical and radiological signs and the insensitivity of current laboratory diagnostic methods. If mortality due to invasive fungal infection is to be reduced, new, preemptive therapeutic strateg...

    journal_title:Current opinion in infectious diseases

    pub_type: 杂志文章,评审

    doi:10.1097/00001432-200312000-00002

    authors: Jones BL,McLintock LA

    更新日期:2003-12-01 00:00:00

  • Male circumcision to reduce the risk of HIV and sexually transmitted infections among men who have sex with men.

    abstract:PURPOSE OF REVIEW:The success of male circumcision in reducing HIV acquisition among African heterosexuals has led to renewed interest in this biological intervention for HIV/sexually transmissible infection (STI) prevention in men who have sex with men (MSM). This review summarizes the available data on the associatio...

    journal_title:Current opinion in infectious diseases

    pub_type: 杂志文章,评审

    doi:10.1097/QCO.0b013e328334e54d

    authors: Templeton DJ,Millett GA,Grulich AE

    更新日期:2010-02-01 00:00:00

  • Bacterial skin infections in a tropical environment.

    abstract::The subject of bacterial skin infection in the tropics has shown some significant advances in the past few years, although it is still relatively understudied. Of special interest is the emerging concern about the public health aspects of pyoderma, either primary or secondary to scabies, in developing countries. In ad...

    journal_title:Current opinion in infectious diseases

    pub_type: 杂志文章,评审

    doi:10.1097/00001432-200104000-00002

    authors: Mahé A

    更新日期:2001-04-01 00:00:00

  • Illicit drug use and its association with sexual risk behaviour among MSM: more questions than answers?

    abstract:PURPOSE OF REVIEW:Illicit drug use before or during sex - known as sexualized drug use (colloquially 'chemsex' or 'party and play') - has evolved as novel psychoactive substances have entered the market in many parts of the world. Here, we review key conceptual issues in associations between illicit drug use and sexual...

    journal_title:Current opinion in infectious diseases

    pub_type: 杂志文章,评审

    doi:10.1097/QCO.0000000000000234

    authors: Melendez-Torres GJ,Bourne A

    更新日期:2016-02-01 00:00:00

  • Chronic aspergillus infections of the respiratory tract: diagnosis, management and antifungal resistance.

    abstract:PURPOSE OF REVIEW:Chronic pulmonary aspergillosis (CPA) is a relatively rare, slowly progressive pulmonary syndrome due to Aspergillus spp. that requires specific knowledge in terms of disease entity, diagnosis, management and azole resistance. This review focuses on the recent understanding of CPA entity and the emerg...

    journal_title:Current opinion in infectious diseases

    pub_type: 杂志文章,评审

    doi:10.1097/QCO.0b013e32833ed694

    authors: Izumikawa K,Takazono T,Kohno S

    更新日期:2010-12-01 00:00:00

  • Therapy of nontuberculous mycobacterial disease.

    abstract:PURPOSE OF REVIEW:Nontuberculous mycobacterial disease, especially pulmonary disease, is increasingly encountered by clinicians. Therapy of the most common nontuberculous mycobacterial pathogen, Mycobacterium avium complex, improved with the introduction of macrolide-containing regimens, but treatment for this and most...

    journal_title:Current opinion in infectious diseases

    pub_type: 杂志文章,评审

    doi:10.1097/QCO.0b013e328055d9a2

    authors: Griffith DE

    更新日期:2007-04-01 00:00:00

  • HIV-1 subtypes: epidemiology and significance for HIV management.

    abstract:PURPOSE OF REVIEW:This review presents an update on the molecular epidemic patterns of HIV-1 infection and the effects of subtype-related genetic variability on transmission, disease progression, response to antiretroviral therapy and drug-resistance pathways. RECENT FINDINGS:The molecular epidemiology of HIV-1 infect...

    journal_title:Current opinion in infectious diseases

    pub_type: 杂志文章,评审

    doi:10.1097/01.qco.0000200293.45532.68

    authors: Geretti AM

    更新日期:2006-02-01 00:00:00

  • Drug combinations for visceral leishmaniasis.

    abstract:PURPOSE OF REVIEW:Several attempts have been made to combine drugs for treating visceral leishmaniasis, but only recently have effective drugs become available and combinations been tested systematically. RECENT FINDINGS:Sequential treatments with liposomal amphotericin B followed by miltefosine or paromomycin (as sho...

    journal_title:Current opinion in infectious diseases

    pub_type: 杂志文章,评审

    doi:10.1097/QCO.0b013e32833fca9d

    authors: Olliaro PL

    更新日期:2010-12-01 00:00:00

  • Antibiotic stewardship: overcoming implementation barriers.

    abstract:PURPOSE OF REVIEW:Antimicrobial stewardship is now recognized as a formal strategy for curbing the upward trend in antibiotic resistance. Literature on antimicrobial stewardship has focused on areas of strategic importance and operational delivery. A number of barriers have been recognized in the implementation of succ...

    journal_title:Current opinion in infectious diseases

    pub_type: 杂志文章,评审

    doi:10.1097/QCO.0b013e3283483262

    authors: Bal AM,Gould IM

    更新日期:2011-08-01 00:00:00