The pharmacokinetics of beta-lactam antibiotics in intensive care patients may be profoundly altered due to the\r\ndynamic, unpredictable pathophysiological changes that occur in critical illness. For many drugs, significant\r\nincreases in the volume of distribution and/or variability in drug clearance are common. When ââ?¬Å?standardââ?¬Â\r\nbeta-lactam doses are used, such pharmacokinetic changes can result in subtherapeutic plasma concentrations,\r\ntreatment failure, and the development of antibiotic resistance. Emerging data support the use of beta-lactam\r\ntherapeutic drug monitoring (TDM) and individualized dosing to ensure the achievement of pharmacodynamic\r\ntargets associated with rapid bacterial killing and optimal clinical outcomes. The purpose of this work was to\r\ndescribe the pharmacokinetic variability of beta-lactams in the critically ill and to discuss the potential utility of TDM\r\nto optimize antibiotic therapy through a structured literature review of all relevant publications between 1946 and\r\nOctober 2011. Only a few studies have reported the utility of TDM as a tool to improve beta-lactam dosing in\r\ncritically ill patients. Moreover, there is little agreement between studies on the pharmacodynamic targets required\r\nto optimize antibiotic therapy. The impact of TDM on important clinical outcomes also remains to be\r\nestablished. Whereas TDM may be theoretically rational, clinical studies to assess utility in the clinical setting are\r\nurgently required.
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