The management of anti-infective agents in intensive care units: the potential role of a ‘fast’ pharmacology

Cattaneo, Dario; Corona, Alberto; Rosa, Francesco Giuseppe De; Gervasoni, Cristina; Kocic, Danijela; Marriott, Deborah

doi:10.1080/17512433.2020.1759413

Cited by 15 publications

(25 citation statements)

References 80 publications

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“…Therapeutic drug monitoring (TDM) plays a pivotal role in the management of infections [ 13 ], so ICU bundles for antimicrobial stewardship include TDM protocols [ 14 ]. However, the correlation between plasma and tissue concentrations of drugs is variable and makes dose adjustment based on TDM findings challenging.…”

Section: Introductionmentioning

confidence: 99%

Tissue Penetration of Antimicrobials in Intensive Care Unit Patients: A Systematic Review—Part II

et al. 2022

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In patients that are admitted to intensive care units (ICUs), the clinical outcome of severe infections depends on several factors, as well as the early administration of chemotherapies and comorbidities. Antimicrobials may be used in off-label regimens to maximize the probability of therapeutic concentrations within infected tissues and to prevent the selection of resistant clones. Interestingly, the literature clearly shows that the rate of tissue penetration is variable among antibacterial drugs, and the correlation between plasma and tissue concentrations may be inconstant. The present review harvests data about tissue penetration of antibacterial drugs in ICU patients, limiting the search to those drugs that mainly act as protein synthesis inhibitors and disrupting DNA structure and function. As expected, fluoroquinolones, macrolides, linezolid, and tigecycline have an excellent diffusion into epithelial lining fluid. That high penetration is fundamental for the therapy of ventilator and healthcare-associated pneumonia. Some drugs also display a high penetration rate within cerebrospinal fluid, while other agents diffuse into the skin and soft tissues. Further studies are needed to improve our knowledge about drug tissue penetration, especially in the presence of factors that may affect drug pharmacokinetics.

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Section: Introductionmentioning

confidence: 99%

Tissue Penetration of Antimicrobials in Intensive Care Unit Patients: A Systematic Review—Part II

et al. 2022

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“…The first challenge for quantification of antibiotics is related to the availability of bioanalytical assays for routine TDM analysis suitable for adoption by nonspecialized laboratories, such as those based in long-term care facilities. Only a limited number of kits based on immunoassays (mainly traditional glycopeptides, aminoglycosides, and linezolid) are available in the market (reviewed in Cattaneo et al 68 ). Commercial LC-MS/MS methods can quantify other drug classes (mainly beta-lactams).…”

Section: Barriers To the Widespread Applications Of Tdm In The Elderl...mentioning

confidence: 99%

“…TDM-Based And/Or PK/PD-Based Targets for Antibiotics Adopted in Our Laboratory or Retrieved From the Literature18,19,68 …”

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Therapeutic Drug Monitoring of Antibiotics in the Elderly: A Narrative Review

Cattaneo

Falcone

Gervasoni

et al. 2022

Therapeutic Drug Monitoring

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Background: Antibiotic dosing adaptation in elderly patients is frequently complicated by age-related changes affecting the processes of drug absorption, distribution, metabolism, and/or elimination. These events eventually result in treatment failure and/or development of drug-related toxicity. Therapeutic drug monitoring (TDM) can prevent suboptimal antibiotic exposure in adult patients regardless of age. However, little data are available concerning the specific role of TDM in the elderly patients.Methods: This review is based on a PubMed search of the literature published in the English language. The search involved TDM studies of antibiotics in the elderly patients performed between 1990 and 2021. Additional studies were identified from the reference lists of the retrieved articles. Studies dealing with population pharmacokinetic modeling were not considered.Results: Only a few studies, mainly retrospective and with observational design, have specifically dealt with appropriate antibiotic dosing in the elderly patients based on TDM. Nevertheless, some clinical situations in which the selection of optimal antibiotic dosing in the elderly patients was successfully guided by TDM were identified. Conclusions:Elderly patients are at an increased risk of bacterial infections and inadequate drug dosing compared with younger patients. Therefore, the availability of TDM services can improve the appropriateness of antibiotic prescriptions in this population.

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“…This makes the management of antimicrobial therapy in these patients extremely challenging. The effects of altered pathophysiology in ICU patients on the pharmacokinetics of antimicrobial agents have been recently reviewed [ 14 ] and are briefly summarized below.…”

Section: Introductionmentioning

confidence: 99%

The Issue of Pharmacokinetic-Driven Drug-Drug Interactions of Antibiotics: A Narrative Review

Cattaneo

Gervasoni

Corona³

2022

Antibiotics

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Patients in intensive care units (ICU) are at high risk to experience potential drug-drug interactions (pDDIs) because of the complexity of their drug regimens. Such pDDIs may be driven by pharmacokinetic or pharmacodynamic mechanisms with clinically relevant consequences in terms of treatment failure or development of drug-related adverse events. The aim of this paper is to review the pharmacokinetic-driven pDDIs involving antibiotics in ICU adult patients. A MEDLINE Pubmed search for articles published from January 2000 to June 2022 was completed matching the terms “drug-drug interactions” with “pharmacokinetics”, “antibiotics”, and “ICU” or “critically-ill patients”. Moreover, additional studies were identified from the reference list of retrieved articles. Some important pharmacokinetic pDDIs involving antibiotics as victims or perpetrators have been identified, although not specifically in the ICU settings. Remarkably, most of them relate to the older antibiotics whereas novel molecules seem to be associated with a low potential for pDDIs with the exceptions of oritavancin as potential perpetrator, and eravacicline that may be a victim of strong CYP3A inducers. Personalized therapeutic drug regimens by means of available web-based pDDI checkers, eventually combined with therapeutic drug monitoring, when available, have the potential to improve the response of ICU patients to antibiotic therapies.

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The management of anti-infective agents in intensive care units: the potential role of a ‘fast’ pharmacology

Cited by 15 publications

References 80 publications

Tissue Penetration of Antimicrobials in Intensive Care Unit Patients: A Systematic Review—Part II

Tissue Penetration of Antimicrobials in Intensive Care Unit Patients: A Systematic Review—Part II

Therapeutic Drug Monitoring of Antibiotics in the Elderly: A Narrative Review

The Issue of Pharmacokinetic-Driven Drug-Drug Interactions of Antibiotics: A Narrative Review

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