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The role of infection models and PK/PD modelling for optimising care of critically ill patients with severe infections
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Infectious Diseases.
Univ Liverpool, Dept Mol & Clin Pharmacol, Liverpool, Merseyside, England..
Univ South Manchester Hosp, Intens Care Unit, Manchester, Lancs, England..
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Pharmaceutical Biosciences.
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2017 (English)In: Intensive Care Medicine, ISSN 0342-4642, E-ISSN 1432-1238, Vol. 43, no 7, 1021-1032 p.Article, review/survey (Refereed) Published
Abstract [en]

Critically ill patients with severe infections are at high risk of suboptimal antimicrobial dosing. The pharmacokinetics (PK) and pharmacodynamics (PD) of antimicrobials in these patients differ significantly from the patient groups from whose data the conventional dosing regimens were developed. Use of such regimens often results in inadequate antimicrobial concentrations at the site of infection and is associated with poor patient outcomes. In this article, we describe the potential of in vitro and in vivo infection models, clinical pharmacokinetic data and pharmacokinetic/ pharmacodynamic models to guide the design of more effective antimicrobial dosing regimens. Individualised dosing, based on population PK models and patient factors (e.g. renal function and weight) known to influence antimicrobial PK, increases the probability of achieving therapeutic drug exposures while at the same time avoiding toxic concentrations. When therapeutic drug monitoring (TDM) is applied, early dose adaptation to the needs of the individual patient is possible. TDM is likely to be of particular importance for infected critically ill patients, where profound PK changes are present and prompt appropriate antibiotic therapy is crucial. In the light of the continued high mortality rates in critically ill patients with severe infections, a paradigm shift to refined dosing strategies for antimicrobials is warranted to enhance the probability of achieving drug concentrations that increase the likelihood of clinical success.

Place, publisher, year, edition, pages
2017. Vol. 43, no 7, 1021-1032 p.
Keyword [en]
Individualised dosing, Antibiotics, Pharmacokinetics, Pharmacodynamics, Mathematical modelling
National Category
Pharmacology and Toxicology Infectious Medicine
Identifiers
URN: urn:nbn:se:uu:diva-333824DOI: 10.1007/s00134-017-4780-6ISI: 000404020100007OAI: oai:DiVA.org:uu-333824DiVA: diva2:1161094
Available from: 2017-11-29 Created: 2017-11-29 Last updated: 2017-11-29Bibliographically approved

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Tängdén, ThomasNielsen, Elisabet I.Friberg, Lena E

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