Burn patients have a number of abnormalities in the early postinjury phase that can significantly impact the efficacy of antimicrobial therapy. These include hypovolemia, hypoalbuminemia, and increasing GFR.
A few pearls when dosing select antibiotics in burn patients:
Aminoglycosides: in the absence of renal impairment, consider more frequent dosing to achieve adequate concentrations.
Beta-lactams: typical doses often don't reach effective concentrations; increase the dose, frequency of administration, or duration of infusion.
Vancomycin: the typical dose of 1 gm is usually ineffective; use a larger loading dose (15-20 mg/kg).
Linezolid: standard doses are usually ineffective; use a higher initial dose.
References
Jamal JA, et al. Improving antibiotic dosing in special situations in the ICU: burns, renal replacement therapy and extracorporeal membrane oxygenation. Curr Opin Crit Care 2012; 18:460-71.
