Title:Continuous Infusion of Antibiotics in Critically Ill Patients
Volume: 8
Issue: 1
Author(s): Piotr Smuszkiewicz, Edyta Szałek, Hanna Tomczak and Edmund Grzeskowiak
Affiliation:
Keywords:
Antibiotics, continuous/intermittent infusion, critically ill patients, pharmacodynamics, pharmacokinetics, Pathophysiology of Sepsis, Acinetobacter baumannii, Pseudomonas aeruginosa, genetic polymorphism, beta-lactams and glycopeptides)
Abstract: Antibiotics are the most commonly used drugs in intensive care unit patients and their supply should be based
on pharmacokinetic/pharmacodynamic rules. The changes that occur in septic patients who are critically ill may be
responsible for subtherapeutic antibiotic concentrations leading to poorer clinical outcomes. Evolving in time the
disturbed pathophysiology in severe sepsis (high cardiac output, glomerular hyperfiltration) and therapeutic interventions
(e.g. haemodynamically active drugs, mechanical ventilation, renal replacement therapy) alters antibiotic pharmacokinetics
mainly through an increase in the volume of distribution and altered drug clearance. The lack of new and
efficacious drugs and increased bacterial resistance are current problems of contemporary antibiotic therapy. Although
intermittent administration is a standard clinical practice, alternative methods of antibiotic administration are sought,
which may potentialise effects and reduce toxicity as well as contribute to inhibition of bacterial resistance. A wide range
of studies prove that the application of continuous infusion of time-dependent antibiotics (beta-lactams, glycopeptides) is
more rational than standard intermittent administration. However, there are also studies which do not confirm the
advantage of one method over the other. In spite of controversy the continuous administration of this group of antibiotics
is common practice, because the results of both studies point to the higher efficacy of this method in critically ill patients.
Authors reviewed the literature to determine whether any clinical benefits exist for administration of time-dependent
antibiotics by continuous infusion. Definite specification of the clinical advantage of administration this way over
standard dosage requires a large-scale multi-centre randomised controlled trial.
