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Semin Respir Crit Care Med 2017; 38(03): 271-286
DOI: 10.1055/s-0037-1602716
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Pharmacokinetic/Pharmacodynamics-Optimized Antimicrobial Therapy in Patients with Hospital-Acquired Pneumonia/Ventilator-Associated Pneumonia

Helmi Sulaiman
1   Burns, Trauma and Critical Care Research Centre, UQ Centre for Clinical Research, Brisbane, Australia
2   Infectious Diseases Unit, Department of Medicine, University of Malaya, Kuala Lumpur, Malaysia
,
Mohd H. Abdul-Aziz
1   Burns, Trauma and Critical Care Research Centre, UQ Centre for Clinical Research, Brisbane, Australia
3   School of Pharmacy, International Islamic University Malaysia, Kuantan, Pahang, Malaysia
,
Jason A. Roberts
1   Burns, Trauma and Critical Care Research Centre, UQ Centre for Clinical Research, Brisbane, Australia
4   Department of Intensive Care Medicine, Royal Brisbane and Women's Hospital, Brisbane, Australia
5   Department of Pharmacy, Royal Brisbane and Women's Hospital, Brisbane, Australia
6   Centre of Translational Pharmacodynamics, The University of Queensland, Brisbane, Australia
› Author Affiliations
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Publication History

Publication Date:
04 June 2017 (online)

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Abstract

Hospital-acquired pneumonia and ventilator-associated pneumonia continue to cause significant morbidity and mortality. With increasing rates of antimicrobial resistance, the importance of optimizing antibiotic treatment is key to maximize treatment outcomes. This is especially important in critically ill patients in intensive care units, in whom the infection is usually caused by less susceptible organisms. In addition, the marked physiological changes that can occur in these patients can cause serious changes in antibiotic pharmacokinetics which in turn alter the attainment of therapeutic drug exposures. This article reviews the various aspects of the pharmacokinetic changes that can occur in the critically ill patients, the barriers to achieving therapeutic drug exposures in pneumonia for systemically delivered antibiotics, the optimization for commonly used antibiotics in hospital- and ventilator-associated pneumonia, the agents that should be avoided in the treatment regimen, as well as the use of adjunctive therapy in the form of nebulized antibiotics.

Keywords

hospital-acquired pneumonia - ventilator-associated pneumonia - antibiotics - critically ill patients - pharmacokinetics - pharmacodynamics - optimization - nebulized antibiotic