Résumé
Efforts directed at maximizing use of the existing antibiotic armamentarium are essential due to persisting increases in antibiotic resistance and the limited number of new antibiotics in development. The intensive care unit (ICU) is an especially complex environment deserving of specific focus. Antibiotic prescription in the ICU is difficult because of the presence of poorly susceptible pathogens, and the dynamic physiology of critically ill patients, which combine to alter bacterial-antibiotic interaction leading to suboptimal treatment of infections. The main objective of this article is to discuss the principles for optimization of antibiotic therapy, specifically focusing on altered pharmacokinetics in the critically ill patient, and the rationale for dosage adjustments. Optimizing antibiotic therapy involves early initiation of appropriate antibiotics, de-escalation where appropriate, minimization of duration of therapy, and avoidance of drug interactions. Furthermore, current opinion suggests that there remains significant capacity for improved antibiotic dosing in the ICU. Application of knowledge of the effect of pathophysiology on drug pharmacokinetics and dose adjustments that adhere to pharmacodynamic principles will facilitate improved antibiotic dosing in these “at risk” ICU patients.