UMEM Educational Pearls

Category: Critical Care

Title: Antibiotic Dosing Matters

Posted: 8/4/2009 by Mike Winters, MD (Updated: 4/1/2023)
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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.


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.