42 - How do I optimize antibiotic use in critical illness?

Abstract

This chapter provides a review of techniques to optimize antibiotic use in critically ill patients. Optimal initial antibiotic selection is paramount to their survival. In this patient population, the key is to select an empiric regimen that not only maximizes antibiotic effect but also limits the development of resistance. “Low resistance potential” antibiotics are antimicrobials that rarely induce resistance among bacteria even when used frequently and for extended periods of time. In addition to selecting antibiotics that have a low resistance potential, consideration should be given toward selecting an agent with favorable pharmacokinetics and pharmacodynamics. Essentially, septic patients should be treated urgently with the highest tolerable/nontoxic antimicrobial dose of a drug with low resistance potential to maximize microbial killing while minimizing the risk of selecting out drug-resistant mutants.