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Antibiotics in ICU - do you know what you're doing?

Todd Fraser on 31-08-2012

The more I read about antibiotics in ICU the less I seem to understand them.  An interesting article published earlier this year by the RENAL investigators revealed that up to 25% of patients on continuous renal replacement in ICU have subtherapeutic trough antibiotic levels.  That's not only staggering, but very concerning given we know how important early appropriate antibiotic prescription is to sepsis outcomes.  And that's in the context of a clinical trial where everything is so tightly controlled.

 

Earlier this year I recorded a podcast with Jason Roberts, a clinical pharmacist with the ICU at Royal Brisbane and Women's hospital.  It was fascinating to hear his thoughts on this area, and it shows how much we still have to learn about this important topic.

 

I'm curious to know if anyone is doing drug levels on anything other than vancomycin and gentamicin.  Does anyone run continuous infusions to get around this problem?  And what about antibiotics in patients getting intermittant haemodialysis in the ICU?  



3 Comments


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Gretel wrote 09-03-2012 12:28:03 pm
Hi Todd,

No, we don't do levels but I've often wondered if we should. I usually run vancomycin as an infusion, but haven't routinely been doing so with beta lactams.

I listened to the podcast with Jason, and the point about hypermetabolic states is really true. I remember a case of a febrile neutropaenic due to chemo who had staph endocarditis. We couldn't get his vanc level up to therapeutic despite 3g tds! I've never seen anyone chew through it that fast.



Peter from Qld wrote 09-08-2012 09:40:27 am
I know in my institution there is no chance of getting beta lactam levels in a time frame that makes any difference.



Todd Fraser wrote 10-07-2012 10:40:07 am
You can check out the podcast with Jason Roberts here - http://crit-iq.com/index.php/Podcast



 

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