β-lactam dosing in critical patients: a narrative review of optimal efficacy and the prevention of resistance and toxicity

Detalhes bibliográficos
Autor(a) principal: Pereira, João Gonçalves
Data de Publicação: 2022
Outros Autores: Fernandes, Joana, Duarte, Ana Rita, Fernandes, Susana M.
Tipo de documento: Artigo
Idioma: eng
Título da fonte: Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
Texto Completo: http://hdl.handle.net/10451/55655
Resumo: © 2022 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
id RCAP_c6b9fe41c923adf70b2ef9789c7fe622
oai_identifier_str oai:repositorio.ul.pt:10451/55655
network_acronym_str RCAP
network_name_str Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
repository_id_str 7160
spelling β-lactam dosing in critical patients: a narrative review of optimal efficacy and the prevention of resistance and toxicityCritical careDosingOrgan failurePharmacodynamicsPharmacokineticsResistanceToxicityβ-lactam© 2022 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).Antimicrobial prescription in critically ill patients represents a complex challenge due to the difficult balance between infection treatment and toxicity prevention. Underexposure to antibiotics and therapeutic failure or, conversely, drug overexposure and toxicity may both contribute to a worse prognosis. Moreover, changes in organ perfusion and dysfunction often lead to unpredictable pharmacokinetics. In critically ill patients, interindividual and intraindividual real-time β-lactam antibiotic dose adjustments according to the patient's condition are critical. The continuous infusion of β-lactams and the therapeutic monitoring of their concentration have both been proposed to improve their efficacy, but strong data to support their use are still lacking. The knowledge of the pharmacokinetic/pharmacodynamic targets is poor and is mostly based on observational data. In patients with renal or hepatic failure, selecting the right dose is even more tricky due to changes in drug clearance, distribution, and the use of extracorporeal circuits. Intermittent usage may further increase the dosing conundrum. Recent data have emerged linking overexposure to β-lactams to central nervous system toxicity, mitochondrial recovery delay, and microbiome changes. In addition, it is well recognized that β-lactam exposure facilitates resistance selection and that correct dosing can help to overcome it. In this review, we discuss recent data regarding real-time β-lactam antibiotic dose adjustment, options in special populations, and the impacts on mitochondria and the microbiome.MDPIRepositório da Universidade de LisboaPereira, João GonçalvesFernandes, JoanaDuarte, Ana RitaFernandes, Susana M.2023-01-05T12:24:26Z20222022-01-01T00:00:00Zinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articleapplication/pdfhttp://hdl.handle.net/10451/55655engAntibiotics (Basel). 2022 Dec 18;11(12):183910.3390/antibiotics111218392079-6382info:eu-repo/semantics/openAccessreponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãoinstacron:RCAAP2023-11-08T17:02:31Zoai:repositorio.ul.pt:10451/55655Portal AgregadorONGhttps://www.rcaap.pt/oai/openaireopendoar:71602024-03-19T22:06:09.612678Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãofalse
dc.title.none.fl_str_mv β-lactam dosing in critical patients: a narrative review of optimal efficacy and the prevention of resistance and toxicity
title β-lactam dosing in critical patients: a narrative review of optimal efficacy and the prevention of resistance and toxicity
spellingShingle β-lactam dosing in critical patients: a narrative review of optimal efficacy and the prevention of resistance and toxicity
Pereira, João Gonçalves
Critical care
Dosing
Organ failure
Pharmacodynamics
Pharmacokinetics
Resistance
Toxicity
β-lactam
title_short β-lactam dosing in critical patients: a narrative review of optimal efficacy and the prevention of resistance and toxicity
title_full β-lactam dosing in critical patients: a narrative review of optimal efficacy and the prevention of resistance and toxicity
title_fullStr β-lactam dosing in critical patients: a narrative review of optimal efficacy and the prevention of resistance and toxicity
title_full_unstemmed β-lactam dosing in critical patients: a narrative review of optimal efficacy and the prevention of resistance and toxicity
title_sort β-lactam dosing in critical patients: a narrative review of optimal efficacy and the prevention of resistance and toxicity
author Pereira, João Gonçalves
author_facet Pereira, João Gonçalves
Fernandes, Joana
Duarte, Ana Rita
Fernandes, Susana M.
author_role author
author2 Fernandes, Joana
Duarte, Ana Rita
Fernandes, Susana M.
author2_role author
author
author
dc.contributor.none.fl_str_mv Repositório da Universidade de Lisboa
dc.contributor.author.fl_str_mv Pereira, João Gonçalves
Fernandes, Joana
Duarte, Ana Rita
Fernandes, Susana M.
dc.subject.por.fl_str_mv Critical care
Dosing
Organ failure
Pharmacodynamics
Pharmacokinetics
Resistance
Toxicity
β-lactam
topic Critical care
Dosing
Organ failure
Pharmacodynamics
Pharmacokinetics
Resistance
Toxicity
β-lactam
description © 2022 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
publishDate 2022
dc.date.none.fl_str_mv 2022
2022-01-01T00:00:00Z
2023-01-05T12:24:26Z
dc.type.status.fl_str_mv info:eu-repo/semantics/publishedVersion
dc.type.driver.fl_str_mv info:eu-repo/semantics/article
format article
status_str publishedVersion
dc.identifier.uri.fl_str_mv http://hdl.handle.net/10451/55655
url http://hdl.handle.net/10451/55655
dc.language.iso.fl_str_mv eng
language eng
dc.relation.none.fl_str_mv Antibiotics (Basel). 2022 Dec 18;11(12):1839
10.3390/antibiotics11121839
2079-6382
dc.rights.driver.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
dc.publisher.none.fl_str_mv MDPI
publisher.none.fl_str_mv MDPI
dc.source.none.fl_str_mv reponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação
instacron:RCAAP
instname_str Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação
instacron_str RCAAP
institution RCAAP
reponame_str Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
collection Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
repository.name.fl_str_mv Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação
repository.mail.fl_str_mv
_version_ 1799134613937848320

Registros relacionados