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\begin{document}

\title{Clinical Pharmacokinetics and dose optimization of anti-infectives in
critical care: A review}



\author[1]{Rachna Rohilla}%
\author[2]{Ritika Kondel}%
\author[1]{Nusrat Shafiq}%
\author[1]{Samir Malhotra}%
\affil[1]{Post Graduate Institute of Medical Education and Research}%
\affil[2]{PGIMER}%


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  \date{May 15, 2024}


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\begin{abstract}
Critically ill patients with infections present with considerable
challenges in antimicrobial use due to multiple reasons such as
pathophysiological alterations, comorbidities, supportive treatment and
the pathogenicity of implicated organism. Fluid shifts, hyperdynamic
state, altered renal clearance are the rapid changes which are often not
considered while administering antimicrobials. Vital organ dysfunction
with or without Multi--Organ Dysfunction Syndrome (MODS) often
necessitates use of supportive management in the form of Ventilatory
Support or Renal Replacement Therapy (RRT) to Extracorpeal Membrane
Oxygenation (ECMO) to name a few. These supportive measures may have
implication on PK-PD of administered antimicrobials. Certain patient
parameters such as age, weight, comorbid illnesses like cystic fibrosis,
burns or immunocompromised state can be important determinants of
pharmacokinetics and pharmacodynamics (PK-PD) of antimicrobials. Issues
such as bioavailability of the antimicrobial at the primary focus of
infection need to be taken into consideration while making choice of
antimicrobial(s) and deciding a dose. The critical pharmacodynamic
parameters that need to be taken into account consider are disease
state, altered bacterial susceptibility, pathogenicity and localization
of the organism and host immunity while making decisions about optimized
antimicrobial treatment in a critically ill patient with infection. The
current review delves on these nuances with a focus on PK-PD for
optimized use of antimicrobials in a critically ill patient.%
\end{abstract}%



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