Antibiotic dosing in the critically ilk asking the same questions but expecting different answers

摘要

The approach of severe sepsis and septic shock has three fundamental steps: early recognition, hemodynamic resuscitation and early empiric antibiotic therapy witfi focus control if appropriate. Empiric antibiotic therapy involves two decisions: the choice of antibiotics, which depends on the presumed focus and pathogens, and dosing of antibiotics, which should be appropriate along with a correct route and mode of administration [1]. In a recent issue of Intensive Care Medicine, Jan De Waele et al. [2] presented data from the Defining Antibiotic Levels in Intensive care unit patients (DALI) study looking at patient characteristics predictive of non-attainment of pharmacokinetic/pharmacodynamic (PK/PD) targets, namely f T > MIC of the suspected pathogen for at least 50 and 100 % of the dosing interval, in intensive care unit (ICU) patients receiving eight different beta-lactams. The DALI project [3] is an international prospective, multicentre, pharmacokinetic point prevalence study involving 68 hospitals, ten countries, with a total of 343 patients, of whom 259 had infection. In the present study, 57 % of patients received penicillins, 27 % carbapenems, and 16 % cephalosporins. Dosing was at the discretion of the treating clinician.