A post-authorisation survey to analyse the perioperative teicoplanin plasma concentrations in adult patients with chronic bone sepsis, who received loading doses of 12 mg/kg 12-hourly for 48 hours followed by 12 mg/kg once daily

Brink, AJ; Richards, Guy A.; Lautenbach, Charles; Rapeport, Naomi; Schillack, V.; Roberts, Jason A.; Lipman, J

doi:10.1186/cc10676

Cited by 2 publications

(1 citation statement)

References 2 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The CL of the free fraction (f f ) was 33.5 L/hour (38.0 -34.7) compared with the bound fraction 7.0 L/hour (6.8 -9.8), and the major determinant of f f was albumin with an OR of 0.120 (0.078 -0.161; p<0.001), with a lesser effect of total dose. This emphasises that multiple factors impact on serum levels whether or not the patients are critically ill. [53] …”

Section: Colistinmentioning

confidence: 99%

Optimising the administration of antibiotics in critically ill patients

2015

View full text Add to dashboard Cite

Optimal outcome and a reduction in the potential for resistance require that appropriate pharmacokinetic (PK) targets are achieved. Consequently, we need to target drug concentrations that are significantly higher than those conventionally presumed to be adequate.Drug exposure varies according to the molecular weight, degree of ionisation, protein binding and lipid solubility of each agent. In critically ill patients, hypoalbuminaemia increases the free fraction of hydrophilic drugs, which in turn increases the volume of distribution and clearance (CL), both of which result in reduced drug levels. Similarly, augmented renal clearance (ARC), defined as a creatinine clearance (CLcr) of >130 mL/min/1.73 m 2 , which occurs frequently in critically ill patients, particularly younger patients with normal or near-normal creatinine levels, may also significantly reduce drug exposure. Studies have demonstrated a greater mortality and lower cure with ARC, particularly with the additive effects of obesity, hypoalbuminaemia and increasing resistance, if conventional dosages are used. These concepts apply to antibiotics targeting Gram-negative and -positive organisms. Knowledge of PK and the resistance profiles of organisms in each environment is necessary to prescribe appropriately. This article discusses these issues and the doses that should be used.

show abstract

Section: Colistinmentioning

confidence: 99%