If you're ever admitted to the intensive care unit (ICU) for an infectious pathology, chances are high that you will be treated with antibiotics. However, getting the right dose of antibiotics can be challenging, especially for critically ill patients.
A team of researchers conducted a clinical trial to determine if model-informed precision dosing of beta-lactam antibiotics and ciprofloxacin would be more effective than the traditional dosing method.
Antibiotics are drugs used to treat or prevent some types of bacterial infections. They work by killing bacteria or preventing them from spreading. Antibiotics have been around for nearly 100 years starting with Alexander Fleming’s discovery of penicillin.
Timely and appropriate antibiotic treatment is vital in treating critically ill patients. Beta-lactam antibiotics and fluoroquinolones such as ciprofloxacin are among the most commonly prescribed antibiotics in intensive care units.
The pharmacologic behavior of these antibiotics is different in critically ill patients compared to the non-critical ones. Consequently, only 60% of patients receiving beta-lactam antibiotics and 30% of patients receiving ciprofloxacin achieve the desired pharmacologic and clinical targets. This is a major issue as it contributes to poor clinical outcomes and increases the chances of the development of antibiotic resistance.
Model-informed precision dosing (MIPD) is an emerging approach to counter these antibiotic dosing discrepancies. It is a method that uses computer models to predict the optimal dose of medication based on individual patient factors such as age, weight, kidney function, and severity of illness. This approach can help clinicians prescribe the right amount of medication to achieve therapeutic levels while minimizing the risk of side effects.
Clinical TrialThe clinical trial was conducted with the aim of determining the safety and effectiveness of MIPD in critically-ill ICU patients.
The trial involved 388 critically ill patients. They were randomly divided into two groups. 189 patients received MIPD while 199 patients received standard antibiotic therapy. ICU length of stay, ICU mortality, hospital mortality, 28-day mortality, 6-month mortality, delta sequential organ failure assessment (SOFA) score, adverse events, and target outcomes were measured.
ResultsThe results of the clinical trial showed that there were no significant differences in the clinical outcomes between the patients in both groups. The length of ICU stay was 10 days in the MIPD group compared to 8 days in the standard group. The blood antibiotic level target attainment was 55.6% in the MIPD group compared to 60.9% in the standard group.
Researchers found that patients who received model-informed precision dosing did not have any beneficial outcomes when compared to the standard antibiotic regimens. These results are significant because they suggest that precision dosing does not improve the effectiveness of antibiotics in critically ill patients. This is important because it highlights the need to develop newer alternatives to MIPD for critically-ill patients.
ConclusionOverall, the clinical trial highlights that the use of precision dosing in the ICU setting is not a feasible approach for critically-ill patients and that newer techniques need to be developed for attaining optimum results from antibiotic therapy.
Intensive Care Medicine, Nov-09-22