Antibiotic Dosing in the Critically Ill Septic Patient
Current international guidelines recommend that intravenous antibiotics begin within one hour for those with severe sepsis and septic shock.
Equally as important as choosing the right antimicrobial is choosing the correct dose at the right dosing schedule.
In fact, there is evidence to suggest improved outcomes in patients given continous antimicrobial infusions (over hours) rather than intermittent bolus dosing (over minutes).
An important cause of underdosing in critically ill patients, especially those with sepsis, is hypoalbuminemia.
It is believed that by increasing the unbound fraction, hypoalbuminemia promotes more extensive distribution and greater renal clearance, thereby increasing the risk of underdosing.
Take Home Point: Critically ill septic patients with hypoalbuminemia require higher dosages, or alternative regimens, to ensure appropriate antimicrobial coverage.
References
Pea F, Viale P. Bench to bedside review: Appropriate antibiotic therapy in severe sepsis and septic shock - does the dose matter? Crit Care 2009;13:214.
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