Abstract
The recent surge in multidrug-resistant pathogens combined with the diminishing antibiotic
pipeline has created a growing need to optimize the use of our existing antibiotic
armamentarium, particularly in the management of intensive care unit (ICU) patients.
Optimal and timely pharmacokinetic/pharmacodynamic (PK/PD) target attainment has been
associated with an increased likelihood of clinical and microbiological success in
critically ill patients. Emerging data, mostly from in vitro and in vivo studies,
suggest that optimization of antibiotic therapy should not only aim to maximize clinical
outcomes but also to include the suppression of resistance. The development of antibiotic
dosing regimens that adheres to the PK/PD principles may prolong the clinical lifespan
of our existing antibiotics by minimizing the emergence of resistance. This article
summarizes the relevance of PK/PD characteristics of different antibiotic classes
on the development of antibiotic resistance. On the basis of the available data, we
propose dosing recommendations that can be adopted in the clinical setting, to maximize
therapeutic success and limit the emergence of resistance in the ICU.
Keywords
antibiotic - resistance - pharmacodynamics - pharmacokinetics - antibiotic dosing
