Dosing of antibacterial agents in obese adults: does one size fit all?

Payne, Kenna D.; Hall, Ronald G.

doi:10.1586/14787210.2014.912942

Cited by 23 publications

(16 citation statements)

References 79 publications

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“…Indeed, guidelines are not very clear regarding computation of AG daily dose in overweight or obese patients. The use of the actual body weight, an adaptation of the ideal body weight plus a percentage of the patient's excess bodyweight, or lean weight is still debatable [13][14][15]. Therefore, efforts should be made to clarify AG dose computation in the overweight population, which may represent more than one third of the patients in many part of the world [16].…”

Section: Discussionmentioning

confidence: 99%

Application of guidelines for aminoglycosides use in French hospitals in 2013–2014

Robert

Péan

Alfandari

et al. 2017

Eur J Clin Microbiol Infect Dis

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In 2011, the French Agency for Safety of Health Products issued guidelines underlining the principles of proper aminoglycosides' use. The aim of the survey was to evaluate adherence to these guidelines two years after their issue. Characteristics of patients receiving aminoglycosides were recorded by voluntary facilities during a 3-month survey in 2013-2014. The modalities of aminoglycosides treatment were analysed by comparison with the French guidelines. A total of 3,323 patients were included by 176 facilities. Patients were mainly hospitalized in medical wards (33.0%), and treated for urinary-tract infections (24.7%). Compliance regarding the clinical indication and the daily aminoglycosides dose was observed in 65.2% and 62.9% of the cases, respectively. A 30-min once-daily IV administration was recorded in 62.5% of the cases. Aminoglycosides treatment duration was appropriate (≤5 days) for 93.6% of the patients. When considering the four criteria together, 23.2% of the patients had a treatment regimen aligned with the guidelines. Requests for measurements of peak and trough AG serum concentrations matched the guidelines in 24.9% and 67.4% of the cases, respectively. Two years after guidelines issue, aminoglycosides use remains unsatisfactory in French health-care facilities. Efforts should be made for guidelines promotion, especially regarding the issue of underdosing.

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Section: Discussionmentioning

confidence: 99%

Application of guidelines for aminoglycosides use in French hospitals in 2013–2014

Robert

Péan

Alfandari

et al. 2017

Eur J Clin Microbiol Infect Dis

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“…Another issue is the increasingly frequent management of obese patients in the ICU. Indeed, obesity has been associated with modifications of beta-lactam PK, notably due to an increased Vd [27, 28]. Indeed, increases in adipose and lean masses and increase in blood volume contribute to increase the Vd of both lipophilic and hydrophilic (such as beta-lactams) antimicrobials [29].…”

Section: Guidelinesmentioning

confidence: 99%

Optimization of the treatment with beta-lactam antibiotics in critically ill patients—guidelines from the French Society of Pharmacology and Therapeutics (Société Française de Pharmacologie et Thérapeutique—SFPT) and the French Society of Anaesthesia and Intensive Care Medicine (Société Française d’Anesthésie et Réanimation—SFAR)

et al. 2019

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Background Beta-lactam antibiotics (βLA) are the most commonly used antibiotics in the intensive care unit (ICU). ICU patients present many pathophysiological features that cause pharmacokinetic (PK) and pharmacodynamic (PD) specificities, leading to the risk of underdosage. The French Society of Pharmacology and Therapeutics (SFPT) and the French Society of Anaesthesia and Intensive Care Medicine (SFAR) have joined forces to provide guidelines on the optimization of beta-lactam treatment in ICU patients. Methods A consensus committee of 18 experts from the two societies had the mission of producing these guidelines. The entire process was conducted independently of any industry funding. A list of questions formulated according to the PICO model (Population, Intervention, Comparison, and Outcomes) was drawn-up by the experts. Then, two bibliographic experts analysed the literature published since January 2000 using predefined keywords according to PRISMA recommendations. The quality of the data identified from the literature was assessed using the GRADE® methodology. Due to the lack of powerful studies having used mortality as main judgement criteria, it was decided, before drafting the recommendations, to formulate only “optional” recommendations. Results After two rounds of rating and one amendment, a strong agreement was reached by the SFPT-SFAR guideline panel for 21 optional recommendations and a recapitulative algorithm for care covering four areas: (i) pharmacokinetic variability, (ii) PK-PD relationship, (iii) administration modalities, and (iv) therapeutic drug monitoring (TDM). The most important recommendations regarding βLA administration in ICU patients concerned (i) the consideration of the many sources of PK variability in this population; (ii) the definition of free plasma concentration between four and eight times the Minimal Inhibitory Concentration (MIC) of the causative bacteria for 100% of the dosing interval as PK-PD target to maximize bacteriological and clinical responses; (iii) the use of continuous or prolonged administration of βLA in the most severe patients, in case of high MIC bacteria and in case of lower respiratory tract infection to improve clinical cure; and (iv) the use of TDM to improve PK-PD target achievement. Conclusions The experts strongly suggest the use of personalized dosing, continuous or prolonged infusion and therapeutic drug monitoring when administering βLA in critically ill patients. Electronic supplementary material The online version of this article (10.1186/s13054-019-2378-9) contains supplementary material, which is available to authorized users.

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“…[1][2][3] The therapeutic windows of many drugs, however, are narrow relative to interpatient metabolic variability, and the accuracy of indirect pharmacokinetic predictors is insufficient to ensure safe dose determination and drug delivery. 1,4,5 Under these circumstances, therapeutic drug monitoring (TDM), the clinical practice in which plasma drug concentrations are measured to adjust dosing, remains the standard of care. [6][7][8] This is particularly true for the most grievously ill patients as this is the population most likely to exhibit altered metabolism and the population for which the margin for therapeutic error is narrowest.…”

Section: Introductionmentioning

confidence: 99%