Farmacocinética y farmacodinámica de los antibióticos betalactámicos en pacientes críticos

Helmi Sulaiman; Jason A. Roberts; Mohd H. Abdul–Aziz

doi:10.7399/fh.13170

Farmacocinética y farmacodinámica de los antibióticos betalactámicos en pacientes críticos

Helmi Sulaiman, Jason A. Roberts, Mohd H. Abdul–Aziz

Resumen

La terapia antibiótica óptima en los pacientes en estado crítico puede
complicarse por la alteración de la fisiología asociada a esta etapa de la
enfermedad. La farmacocinética y la exposición a los antibióticos pueden
verse alteradas por la enfermedad crítica subyacente y las intervenciones
médicas que reciben estos pacientes en la unidad de cuidados intensivos.
Además, las cepas que suelen encontrarse en la unidad de cuidados intensivos
suelen ser menos susceptibles y “resistentes” a los antibióticos más
habituales. De hecho, una dosificación de antibióticos que no tenga en
cuenta estas diferencias únicas, probablemente fracasará y dará lugar a
resultados clínicos deficientes y a la aparición de resistencia a los antibióticos
en la unidad de cuidados intensivos. Los objetivos de esta revisión son
describir la farmacocinética de los antibióticos betalactámicos en pacientes
críticos, destacar los objetivos farmacocinéticos/farmacodinámicos para
los pacientes y exponer algunas estrategias importantes que pueden optimizar
la dosificación de los antibióticos betalactámicos en pacientes críticos
en la unidad de cuidados intensivos.

Palabras clave

Antibióticos; Beta-lactámicos; Paciente crítico; Farmacocinética clínica

Texto completo:

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Referencias

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Abdulla A, Ewoldt TM, Hunfeld NGM, Muller AE, Rietdijk WJR, Polinder S, et al. The effect of therapeutic drug monitoring of beta- lactam and fluoroquinolones on clinical outcome in critically ill patients: the DOLPHIN trial protocol of a multicentre randomised controlled trial. BMC Infect Dis. 2020;20:57. DOI: 10.1186/s12879-020-4781-x

Wong G, Briscoe S, McWhinney B, Ally M, Ungerer J, Lipman J, et al. Therapeutic drug monitoring of β-lactam antibiotics in the critically ill: direct measurement of unbound drug concentrations to achieve appropriate drug exposures. J Antimicrob Chemother. 2018;73:3087-94. DOI: 10.1093/jac/dky314

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Patel BM, Paratz J, See NC, Muller MJ, Rudd M, Paterson D, et al. Therapeutic drug monitoring of beta-lactam antibiotics in burns patients —a oneyear prospective study. Ther Drug Monit. 2012;34:160-4. DOI: 10.1097/FTD.0b013e31824981a6

Roberts JA, Ulldemolins M, Roberts M, Roberts MS, McWhinney B, Ungerer J, et al. Therapeutic drug monitoring of β-lactams in critically ill patients: proof of concept. Int J Antimicrob Agents. 2010;36:332-9. DOI: 10.1016/j.ijantimicag. 2010.06.008

DOI: http://dx.doi.org/10.7399%2Ffh.13170