Antimicrobial safety considerations in critically ill patients: part II: focused on anti-microbial toxicities

ABSTRACT

Introduction

Antibiotic prescription is a challenging issue in critical care settings. Different pharmacokinetic and pharmacodynamic properties, polypharmacy, drug interactions, and high incidence of multidrug-resistant microorganisms in this population can influence the selection, safety, and efficacy of prescribed antibiotics.

Areas covered

In the current article we searched PubMed, Scopus and Google Scholar for neurotoxicities, hematologic toxicity and fluid stewardship in intensive care units.

Expert opinion

Critically ill patients who receive antimicrobial agents should be monitored for neurological, hematologic toxicities especially seizure, thrombocytopenia, and clostridioides infections. Other toxicities including QTc prolongation, electrolyte disturbances, liver enzyme elevation, and infusion-related reactions were being considered. Other changes, including fluid overload, hypoalbuminemia, augmented renal clearance, increased cardiac outputs in septic shock, and acute kidney injury, may influence treatment efficiency and patient outcome.

KEYWORDS:

• Anti-infective agents
• fluid therapy
• Clostridioides difficile
• neurocognitive disorders
• hematologic toxicities

View correction statement:

Correction

Article highlights

• Monitoring of patients for hidden fluids and electrolytes during treatment with antimicrobial agents is an essential way to reduce positive fluid balance.

• Antimicrobial-associated different central nervous system side effects may occur in ICU patients.

• Hidden sources of fluid and electrolytes may affect patients’ outcomes in critically ill patients.

• Antimicrobial induced hematologic toxicity is a differential diagnosis and should not be neglected in ICU patients.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.