ABSTRACT
Monitoring plasma concentrations of antimicrobial agents used to treat infection in critically ill patients is one of the recommended strategies for improving clinical outcome. Drug monitoring has a double aim: to limit adverse events and to increase the effectiveness of the drugs. In clinical practice, however, this approach is mainly limited to monitoring plasma concentrations of vancomycin and aminoglycosides, although future extension to other antimicrobial agents would be desirable. Application of this technique varies considerably between hospitals, and this makes interpretation and comparison of the results obtained difficult. For this reason, representatives of various scientific societies related to the pharmacokinetic area have developed a series of recommendations for monitoring plasma concentrations of antimicrobials using vancomycin and several aminoglycosides as the reference. The recommendations are based on 14 questions encompassing all steps of the process: indication for the test, blood sampling (timing of blood collection, blood volume, tubes), transport to the laboratory, techniques applied, normal values, dose adjustment, and reporting the results. The purpose of these guidelines is to develop a process of monitoring plasma antimicrobial concentrations that is as homogeneous as possible to facilitate the design of multicenter studies, as well as the interpretation and comparison of results.
Subject(s)
Anti-Bacterial Agents/therapeutic use , Critical Illness , Drug Monitoring , Intensive Care Units , Humans , Vancomycin/therapeutic useABSTRACT
UNLABELLED: Monitoring plasma concentrations of antimicrobial agents used to treat infection in critically ill patients is one of the recommended strategies for improving clinical outcome. Drug monitoring has a double AIM: to limit adverse events and to increase the effectiveness of the drugs. In clinical practice, however, this approach is mainly limited to monitoring plasma concentrations of vancomycin and aminoglycosides, although future extension to other antimicrobial agents would be desirable. Application of this technique varies considerably between hospitals, and this makes interpretation and comparison of the results obtained difficult. For this reason, representatives of various scientific societies related to the pharmacokinetic area have developed a series of recommendations for monitoring plasma concentrations of antimicrobials using vancomycin and several aminoglycosides as the reference. The recommendations are based on 14 questions encompassing all steps of the process: indication for the test, blood sampling (timing of blood collection, blood volume, tubes), transport to the laboratory, techniques applied, normal values, dose adjustment, and reporting the RESULTS: The purpose of these guidelines is to develop a process of monitoring plasma antimicrobial concentrations that is as homogeneous as possible to facilitate the design of multicenter studies, as well as the interpretation and comparison of results.
Subject(s)
Anti-Bacterial Agents/analysis , Critical Illness , Drug Monitoring/methods , Humans , Intensive Care Units , Surveys and QuestionnairesABSTRACT
La monitorización de concentraciones plasmáticas de los antimicrobianos utilizados para el tratamiento de infecciones en pacientes críticos es una de las estrategias planteadas para mejorar los resultados clínicos. El objetivo de la monitorización es doble: limitar los efectos adversos y aumentar la efectividad de los antimicrobianos. Su desarrollo clínico se limita prácticamente a la monitorización de vancomicina y aminoglucósidos, aunque es deseable su extensión, en el futuro, al resto de antimicrobianos. La aplicación de esta técnica está sometida a múltiples variaciones entre hospitales, lo que dificulta la interpretación y comparación de resultados. Por este motivo, representantes de diversas sociedades científicas relacionadas con el área de la farmacocinética han elaborado un conjunto de recomendaciones para la monitorización plasmática de antimicrobianos utilizando como referencia la vancomicina y los distintos aminoglucósidos. La recomendaciones se realizan en torno a 14 preguntas que abarcan todas las etapas de proceso: indicación de la prueba, extracción de la muestra (tiempo de extracción, cantidad de sangre, tubos), traslado al laboratorio, técnicas aplicables, valores de normalidad, ajuste de dosis y comunicación de resultados. El objetivo de las recomendaciones es homogeneizar en la medida de lo posible el proceso de la monitorización de estos antimicrobianos y facilitar con ello la realización de estudios multicéntricos y la comparación e interpretación de los resultados (AU)
Monitoring plasma concentrations of antimicrobial agents used to treat infection in critically ill patients is one of the recommended strategies for improving clinical outcome. Drug monitoring has a double aim: to limit adverse events and to increase the effectiveness of the drugs. In clinical practice, however, this approach is mainly limited to monitoring plasma concentrations of vancomycin and aminoglycosides, although future extension to other antimicrobial agents would be desirable. Application of this technique varies considerably between hospitals, and this makes interpretation and comparison of the results obtained difficult. For this reason, representatives of various scientific societies related to the pharmacokinetic area have developed a series of recommendations for monitoring plasma concentrations of antimicrobials using vancomycin and several aminoglycosides as the reference. The recommendations are based on 14 questions encompassing all steps of the process: indication for the test, blood sampling (timing of blood collection, blood volume, tubes), transport to the laboratory, techniques applied, normal values, dose adjustment, and reporting the results. The purpose of these guidelines is to develop a process of monitoring plasma antimicrobial concentrations that is as homogeneous as possible to facilitate the design of multicenter studies, as well as the interpretation and comparison of results (AU)
Subject(s)
Humans , Critical Care/methods , Critical Illness/therapy , Communicable Diseases/drug therapy , Anti-Bacterial Agents/pharmacokinetics , Drug Monitoring/methods , Cross Infection/drug therapy , Practice Patterns, Physicians'ABSTRACT
An experimental model of artificially perfused and mechanically ventilated lung has been applied to compare the kinetic behaviour of levofloxacin, cefepime and netilmicin in this body tissue. The study has been performed to explore the usefulness of the isolated lung technique in the pharmacokinetic field, particularly to study the disposition of antibiotics in pulmonary tissue. The lung was perfused with Krebs-Henseleit medium containing 3% bovine albumin at a flow rate of 5 mL min(-1). It was ventilated at 60 respirations/min with a 2-mL tidal volume of air previously humidified and warmed to 37 degrees C. The concentrations of the above antibiotics were determined by HPLC techniques and the outflow curves were analysed by stochastic, as well as by model-dependent, methods. The results show pharmacokinetic differences among these antibiotics, which are in accordance with previously reported data, levofloxacin being the drug with the highest distribution coefficient in this tissue (1.25 +/- 0.14 vs 0.39 +/- 0.07 and 0.41 +/- 0.06 mL g(-1) for netilmicin and cefepime, respectively). Accordingly, the isolated lung of the rat, under the experimental conditions used here, constitutes an alternative model to be incorporated to pharmacokinetic studies with a great potential use for those drugs that show a pharmacological or toxicological action depending on the kinetic profile in the lung tissue.
