Individualised dosing

Critically ill patients have dramatically varied PK compared with non-critically ill patients and are more likely to be infected by less susceptible bacteria. Traditional antibiotic dosing strategies are unlikely to consistently achieve PK/PD targets associated with maximal antibiotic activity thereby putting the patient at risk of clinical failure, the development of resistance, or both.  Optimization of antibiotic dosing in the ICU, therefore, requires an individualized approach for the patient that considers the MIC of the infecting pathogen and selects a dosing regimen that provides a high likelihood of obtaining the requisite PK/PD index predictive of success.  The challenges are clearly here, but so too are the solutions.  Pro-active therapeutic management for antibiotics other than vancomycin and aminoglycosides is possible, but needs to be escalated to the next level and made available to all hospitals.  The ability to acquire individualized antibiotic concentrations, combined with access to available software programs as described here will increase dosing accuracy and the likelihood of achieving PK/PD targets in our patients (J Roberts et al, submitted).

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