| Autor: |
Delattre, Isabelle K., Taccone, Fabio S., Jacobs, Frédérique, Hites, Maya, Dugernier, Thierry, Spapen, Herbert, Laterre, Pierre-François, Wallemacq, Pierre E., Van Bambeke, Françoise, Tulkens, Paul M., Jacobs, Frédérique, Laterre, Pierre-François, Van Bambeke, Françoise |
| Předmět: |
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| Zdroj: |
Expert Review of Anti-infective Therapy; Jul2017, Vol. 15 Issue 7, p677-688, 12p |
| Abstrakt: |
Introduction: The pharmacokinetic/pharmacodynamic index determining β-lactam activity is the percentage of the dosing interval (%T) during which their free serum concentration remains above a critical threshold over the minimum inhibitory concentration (MIC). Regrettably, neither the value of %T nor that of the threshold are clearly defined for critically-ill patients. Areas covered: We review and assess the targets proposed for β-lactams in critical illness by screening the literature since 1997. Depending on the study intention (clinical cure vs. suppression of resistance), targets proposed range from 20%T > 1xMIC to 100%T > 5xMIC. Assessment and comparative analysis of their respective clinical efficacy suggest that a value of 100%T > 4xMIC may be needed. Simulation studies, however, show that this target will not be reached at first dose for the majority of critically-ill patients if using the most commonly recommended doses. Expert commentary: Considering that critically-ill patients are highly vulnerable and likely to experience antibiotic underexposure, and because effective initial treatment is a key determinant of clinical outcome, we support the use of a target of 100%T > 4xMIC, which could not only maximize efficacy but also minimize emergence of resistance. Clinical and microbiological studies are needed to test for the feasibility and effectiveness of reaching such a demanding target. [ABSTRACT FROM AUTHOR] |
| Databáze: |
Complementary Index |
| Externí odkaz: |
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