Strategies in antibiotic therapy #EuAsia18

Nebulised antibiotics (J Oto)

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Choice of antibiotics for nebulisation

  • not all antibiotics can be nebulised
  • produce high local concentrations with rapid clearance (poor systematic exposure)

Efficiency of abx nebulisation

  • Particle size
  • Nebuliser type
  • Nebuliser position
  • Circuit humidification management
  • Ventilator settings to avoid turbulence

Nebulization of Antiinfective Agents in Invasively Mechanically Ventilated Adults: A Systematic Review and Meta-analysis.

Nebulized Versus IV Amikacin as Adjunctive Antibiotic for Hospital and Ventilator-Acquired Pneumonia Postcardiac Surgeries: A Randomized Controlled Trial.

Conclusion

  • Nebulised abx provides high lung concentration
  • VAP caused by resistant gram negatives may be efficiently treated by nebulised abx without nephrotoxicity
  • Optimisation of nebulisation techniques and procedures needed

 

Optimising Beta Lactam Therapy (A Wong)

PowerPoint Slides

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Continuous versus Intermittent β-Lactam Infusion in Severe Sepsis. A Meta-analysis of Individual Patient Data from Randomized Trials.

Continuous Infusion Versus Intermittent Bolus of Beta-Lactams in Critically Ill Patients with Respiratory Infections: A Systematic Review and Meta-analysis.

Continuous infusion of β-lactam antibiotics for all critically ill patients?

Prolonged infusion piperacillin-tazobactam decreases mortality and improves outcomes in severely ill patients: Results of a systematic review and meta-analysis

An international, multicentre survey of β-lactam antibiotic therapeutic drug monitoring practice in intensive care units.

Using Old Antibiotics in 2018 (J De Waele)

IMG_3114

Challenges of old antibiotics

  • Lack of clinical evidence
    • Research in that era different
    • No guidance on RCTs
    • No combination therapy
    • Now used for other indications
  • Availability lacking due to manufacturing and logistical issues
  • Dosing
    • Data based on obsolete data
  • Susceptibility data
    • Lacking for many
    • Not standardised
    • Potential for resistance