Optimizing Antimicrobial Therapy in I.C.U Patients

Abstract

Sepsis continues to be a significant cause of mortality and morbidity. Rapid identification and treatment of the patient with sepsis is vital to improve outcomes. Early and appropriate antimicrobial therapy is an essential component of sepsis care. Pharmacokinetic and pharmacodynamic data should be used to optimize antimicrobial therapy and, when possible, individualize therapy. Critical care pharmacists play an essential role in developing effective antimicrobial treatment regimens, promoting good antimicrobial stewardship, developing institutional sepsis protocols, and educating on the proper use of antimicrobials. Selection of empiric antibiotic therapy is an important factor to consider, especially with the higher rates of resistance within patients in the ICU. Empiric antibiotic therapy should be sufficiently broad-spectrum to cover the most likely pathogens while taking in account local susceptibility patterns. Antibiotics should be given in doses sufficient to take into account altered pharmacokinetic and pharmacodynamics properties of ICU patients in the presence of any renal or hepatic dysfunction. In patients who respond to initial therapy or when susceptibilities are known, de-escalation of therapy is recommended because it decreases the selection pressure for the development of resistance and potentially may decrease treatment cost. Optimal duration is important because prolonged duration of antibiotic therapy increases the emergence of resistance, drug cost and the potential for adverse drug events. Antimicrobial stewardship measures have been shown to be productive in the