Individualized antibiotic therapy in the treatment of severe infections

ABSTRACT

Introduction: Sepsis is a frequent and life-threatening clinical entity and antibiotic treatment is one of the most important interventions, together with source control and hemodynamic resuscitation. Guidelines have highlighted the importance of an early (i.e. within 1–3 h from recognition) and appropriate (i.e. the pathogen is sensitive in vitro to the administered drug) antimicrobial therapy in this setting.

Areas covered: Antibiotic therapy should be individualized according to several issues, including early pathogen identification, optimal drug regimens based on pharmacokinetic/pharmacodynamics (PK/PD) and adequate duration using both clinical and biological biomarkers. This narrative review has considered the most relevant studies evaluating these issues.

Expert opinion: Rapid identification pathogen resistance profile (i.e. the minimal inhibitory concentration for the available antimicrobials), real-time measurement of drug concentrations with regimen adjustment on MIC and daily measurement of procalcitonin to guide duration of therapy are the main issues to individualize the antibiotic management in critically ill patients.

KEYWORDS:

• Antibiotic
• sepsis
• individualized therapy
• critically ill
• pharmacokinetic
• pharmacodynamics
• procalcitonin

Article highlights

• The first step to individualize antibiotic therapy in critically ill patients is to assess the minimal inhibitory concentrations (MIC) for different antimicrobials

• Drug regimens should include a higher than standard loading dose followed by a daily regimen based on the MIC; in case of very sensitive pathogens, standard regimens would be sufficient. In case of less sensitive bugs with higher MICs, drug dosing should be adjusted on PK principles.

• Antimicrobials TDM should be routinely available for most antimicrobials and be used to adjust daily drug regimens

• Daily assessment of PCT should be used to guide the duration of antibiotic therapy in this setting

Declaration of interest

FS Taccone received lecture fees from Roche and Accelerate Diagnostics. The authors have no other 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 apart from those disclosed.

Reviewer disclosures

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

Additional information

Funding

This paper was not funded.