Antimicrobial Dosing in Intensive Care Units

Dear Colleagues,

Antimicrobial stewardship encompasses a number of strategies aiming to decrease the emergence and spread of resistant microorganisms and seeks to preserve the efficacy of existing antimicrobials, ensuring they are only used when clinically needed.

During critical illness, patients suffer considerable physiological disturbances, which directly impact drug pharmacokinetics and pharmacodynamics. This in turn affects clinical efficacy, pathogen suppression, and eradication, with resulting impacts on patient morbidity and mortality. In the intensive care unit (ICU), a high value is placed on ensuring that patients receive the right treatment for the right infection, at the right dose and at the right time. Therapeutic drug monitoring (TDM) is therefore commonly employed in this population to optimize the efficacy of dosing and safety parameters.

Dysregulated and exaggerated inflammatory responses and immunological changes are often encountered in ICU patients, where systemic infection and/or inflammation lead to sepsis. Sepsis is characterized by organ failure and can rapidly become life-threatening. The principles of the right treatment for the infection, at the right dose and at the right time, are key, and appropriate antimicrobial agents must be started promptly following diagnosis to limit morbidity and mortality. At initial presentation, the infecting organism is seldom known, and early therapy is almost invariably empiric. The key to effective antimicrobial stewardship is ensuring that infective diagnoses are confirmed or refuted and that the need for prompt antimicrobial therapy in life-threatening sepsis does not lead to excessive use of these agents in patients with lower suspicion of infection or milder degrees of illness.

There are often competing and complicating factors when assessing the appropriate dosing of medicines in critically ill patients. Inflammatory processes and fluid therapy often lead to fluid accumulation and overload. This increases the weight and volume of the distribution of water-soluble medicines, necessitating careful consideration of appropriate dosing weights. In addition to this, renal function may either become augmented or impaired and changes to plasma protein levels occur, resulting in altered drug clearance and drug serum concentrations. The critical care population encountered in clinical practice also continues to increase in complexity, with many patients often reporting pre-existing co-morbidities, including immunosuppression and advanced age, all requiring careful consideration in antimicrobial therapy choice and dosing optimization.

In this Special Issue on ‘Antimicrobial Dosing in Intensive Care Units’, we welcome articles, including reviews, on this topic. This can include any studies that describe any aspect of the management of patients undergoing antimicrobial therapy in ICU settings.

Acknowledgments: Mr David Sapsford and Mrs Laura Coslett will be participating in this Special Issue as specialist advisors. We would like to thank them for their contributions to this Special Issue.

Dr. Christianne Micallef
Dr. Andrew Conway Morris
Dr. James Varley
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Antibiotics is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

• pharmacokinetics
• pharmacodynamics
• intensive care
• pharmacology
• antibiotics
• antivirals
• antifungals
• antiparasitic agents
• antimicrobials
• multi-drug resistant infections
• pharmacy
• therapeutic drug monitoring
• dosing in obesity
• interactions
• renal dysfunction
• renal replacement therapy
• augmented renal clearance
• hepatic dysfunction
• transplant
• immunosuppression
• advanced age
• sepsis
• septic shock
• respiratory Failure
• ventilation
• extracorporeal membrane oxygenation (ECMO)