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Antibiotic Dosing in the Critically Ill Septic Patient
- Current international guidelines recommend that intravenous antibiotics begin within one hour for those with severe sepsis and septic shock.
- Equally as important as choosing the right antimicrobial is choosing the correct dose at the right dosing schedule.
- In fact, there is evidence to suggest improved outcomes in patients given continous antimicrobial infusions (over hours) rather than intermittent bolus dosing (over minutes).
- An important cause of underdosing in critically ill patients, especially those with sepsis, is hypoalbuminemia.
- It is believed that by increasing the unbound fraction, hypoalbuminemia promotes more extensive distribution and greater renal clearance, thereby increasing the risk of underdosing.
- Take Home Point: Critically ill septic patients with hypoalbuminemia require higher dosages, or alternative regimens, to ensure appropriate antimicrobial coverage.
References
Pea F, Viale P. Bench to bedside review: Appropriate antibiotic therapy in severe sepsis and septic shock - does the dose matter? Crit Care 2009;13:214.