The septic patient

Abstract

Improving the outcome of critically ill septic patients requires giving appropriate antibiotic(s), as early as possible and at correct doses. Empirical antibiotic therapy will require knowledge of possible anatomic site of infection, local resistance patterns and presence of any of the risk factors for multi-resistant pathogens. The more severe the infection, the more urgent is the need to administer antibiotics. Combination antibiotic therapy will sometimes be required especially if the patient has risk factors for multi-resistant pathogens. After 48 of treatment, earnest attempt has to be made to de-escalate especially when the sources of infection with sensitivities are known. Duration of antimicrobial therapy often has to be tailored according to the treatment response. Optimising the dose of antibiotic therapy requires knowledge of the alterations to their pharmacokinetics and pharmacodynamics in the critically ill setting. Volume of distribution and clearance are especially affected for the hydrophilic antibiotics. This entails the need to administer loading doses for some of the concentration dependent and time dependent antibiotics and for more frequent dosing for time dependent antibiotics. Hypoalbuminemia which is common in the critically ill patients, results in the alteration in the pharmacodynamics of highly protein bound antibiotics. In such situations, highly protein bound antibiotics will need to be given in higher dose or more frequently.