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. 2023 Jun 19;27(1):241.
doi: 10.1186/s13054-023-04527-1.

International survey of antibiotic dosing and monitoring in adult intensive care units

Paul G Williams  1   2 , Alexis Tabah  3   4   5 , Menino Osbert Cotta  3 , Indy Sandaradura  6   7   8 , Salmaan Kanji  9 , Marc H Scheetz  10 , Sahand Imani  11 , Muhammed Elhadi  12 , Sònia Luque-Pardos  13   14   15 , Natalie Schellack  16 , Cristina Sanches  17 , Jean-Francois Timsit  18   19 , Jiao Xie  20 , Andras Farkas  21   22 , Kathryn Wilks  23   24 , Jason A Roberts  3   25   26   27 ; National Coordinators on behalf of the European Society of Intensive Care Medicine (ESICM) and the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Study Group for Infections in Critically Ill Patients [ESGCIP]
Collaborators, Affiliations

International survey of antibiotic dosing and monitoring in adult intensive care units

Paul G Williams et al. Crit Care. .

Abstract

Background: In recent years, numerous dosing studies have been conducted to optimize therapeutic antibiotic exposures in patients with serious infections. These studies have led to the inclusion of dose optimization recommendations in international clinical practice guidelines. The last international survey describing dosing, administration and monitoring of commonly prescribed antibiotics for critically ill patients was published in 2015 (ADMIN-ICU 2015). This study aimed to describe the evolution of practice since this time.

Methods: A cross-sectional international survey distributed through professional societies and networks was used to obtain information on practices used in the dosing, administration and monitoring of vancomycin, piperacillin/tazobactam, meropenem and aminoglycosides.

Results: A total of 538 respondents (71% physicians and 29% pharmacists) from 409 hospitals in 45 countries completed the survey. Vancomycin was mostly administered as an intermittent infusion, and loading doses were used by 74% of respondents with 25 mg/kg and 20 mg/kg the most favoured doses for intermittent and continuous infusions, respectively. Piperacillin/tazobactam and meropenem were most frequently administered as an extended infusion (42% and 51%, respectively). Therapeutic drug monitoring was undertaken by 90%, 82%, 43%, and 39% of respondents for vancomycin, aminoglycosides, piperacillin/tazobactam, and meropenem, respectively, and was more frequently performed in high-income countries. Respondents rarely used dosing software to guide therapy in clinical practice and was most frequently used with vancomycin (11%).

Conclusions: We observed numerous changes in practice since the ADMIN-ICU 2015 survey was conducted. Beta-lactams are more commonly administered as extended infusions, and therapeutic drug monitoring use has increased, which align with emerging evidence.

Keywords: Aminoglycosides; Beta-lactams; Drug monitoring; Intensive care units; Vancomycin.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Infusion duration and TDM utilization according to antibiotics. Abbreviations: TDM, therapeutic drug monitoring n, number; %, percentage
Fig. 2
Fig. 2
Dosing according to A, vancomycin loading dose (LD); B, vancomycin maintenance dose (MD); C, amikacin*; D, gentamicin*; E, tobramycin*. Values presented as median (IQR), Abbreviations: IQR, interquartile range; loading dose; II, intermittent infusion, CI, continuous infusion; ABW, actual body weight, IBW, ideal body weight; AdjBW, adjusted body weight; MD; maintenance dose; n, number; *, once daily dosing
See this image and copyright information in PMC

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