Optimization of the treatment with beta-lactam antibiotics in critically ill patients—guidelines from the French Society of Pharmacology and Therapeutics (Société Française de Pharmacologie et Thérapeutique—SFPT) and the French Society of Anaesthesia and Intensive Care Medicine (Société Française d’Anesthésie et Réanimation—SFAR)
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BACKGROUND: Beta-lactam antibiotics (βLA) are the most commonly used antibiotics in the intensive care unit (ICU). ICU patients present many pathophysiological features that cause pharmacokinetic (PK) and pharmacodynamic (PD) specificities, leading to the risk of underdosage. The French Society of Pharmacology and Therapeutics (SFPT) and the French Society of Anaesthesia and Intensive Care Medicine (SFAR) have joined forces to provide guidelines on the optimization of beta-lactam treatment in ICU patients. METHODS: A consensus committee of 18 experts from the two societies had the mission of producing these guidelines. The entire process was conducted independently of any industry funding. A list of questions formulated according to the PICO model (Population, Intervention, Comparison, and Outcomes) was drawn-up by the experts. Then, two bibliographic experts analysed the literature published since January 2000 using predefined keywords according to PRISMA recommendations. The quality of the data identified from the literature was assessed using the GRADE® methodology. Due to the lack of powerful studies having used mortality as main judgement criteria, it was decided, before drafting the recommendations, to formulate only "optional" recommendations. RESULTS: After two rounds of rating and one amendment, a strong agreement was reached by the SFPT-SFAR guideline panel for 21 optional recommendations and a recapitulative algorithm for care covering four areas: (i) pharmacokinetic variability, (ii) PK-PD relationship, (iii) administration modalities, and (iv) therapeutic drug monitoring (TDM). The most important recommendations regarding βLA administration in ICU patients concerned (i) the consideration of the many sources of PK variability in this population; (ii) the definition of free plasma concentration between four and eight times the Minimal Inhibitory Concentration (MIC) of the causative bacteria for 100% of the dosing interval as PK-PD target to maximize bacteriological and clinical responses; (iii) the use of continuous or prolonged administration of βLA in the most severe patients, in case of high MIC bacteria and in case of lower respiratory tract infection to improve clinical cure; and (iv) the use of TDM to improve PK-PD target achievement. CONCLUSIONS: The experts strongly suggest the use of personalized dosing, continuous or prolonged infusion and therapeutic drug monitoring when administering βLA in critically ill patients.
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Dosing antibiotics according to PK/PD principles and using regimens developed in sepsis/septic shock patients is more likely to achieve effective and safe drug concentrations than using manufacturer's product information.
“Administration of antibiotics using an approach that adheres to PK/PD principles and using dosing regimens developed in patients with sepsis and septic shock is more likely to result in effective and safe drug concentrations compared to use of dosing recommendations provided in the manufacturer’s product information [247].”
From Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021 (2021) · cites this paper as [247]
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Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021.
Evans, L., Rhodes, A., Alhazzani, W., Antonelli, M., Coopersmith, C. M., French, C., Machado, F. R., Mcintyre, L., Ostermann, M., Prescott, H. C., et al. (2021) · Critical Care Medicine · doi:10.1097/ccm.0000000000005337 · Cited by 2,935 · see citing works
Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021
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- Authors
- Guilhaumou, R., Benaboud, S., Bennis, Y., Dahyot-Fizelier, C., Dailly, E., Gandia, P., Goutelle, S., Lefeuvre, S., Mongardon, N., Roger, C., Scala-Bertola, J., Lemaitre, F., & Garnier, M.
- Affiliations
- Assistance Publique Hôpitaux de Marseille (FR)
- Hôpital Cochin (FR)
- Centre Hospitalier Universitaire Amiens-Picardie (FR)
- Centre Hospitalier Universitaire de Toulouse (FR)
- Inserm (FR)
- Centre hospitalier universitaire d'Orléans (FR)
- Centre Hospitalier Universitaire Henri-Mondor (FR)
- Centre Hospitalier Universitaire de Nîmes (FR)
- Hôpital Pontchaillou (FR)
- Assistance Publique – Hôpitaux de Paris (FR)
- Corresponding author
- Garnier, Marc
- ORCID
- Venue
- Critical Care
- Published
- 2019-03-29
- Volume
- 23
- Issue
- 1
- Pages
- 104-104
- ISSN
- 1364-8535 (ISSN-L)
- PMC
- PMC6441232
- OpenAlex
- W2929478224
- Cited by
- 543
- References
- 134
- Citations by year
- 2026: 72 · 2025: 80 · 2024: 92 · 2023: 79 · 2022: 86 · 2021: 73 · 2020: 44 · 2019: 17
- FWCI
- 34.09
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Critical Care (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- HAL (submittedVersion, other-oa)
- HAL (submittedVersion)
- HAL AMU (submittedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Topics
- Health Sciences › Medicine › Pharmacology › Antibiotics Pharmacokinetics and Efficacy
- Health Sciences › Medicine › Epidemiology › Sepsis Diagnosis and Treatment
- Life Sciences › Immunology and Microbiology › Applied Microbiology and Biotechnology › Antibiotic Use and Resistance
- Keywords
- beta-lactam antibiotics, critically ill patients, intensive care unit, individualized dosing, pharmacokinetic variability, PK/PD relationship, therapeutic drug monitoring, continuous infusion, prolonged infusion, minimum inhibitory concentration, lower respiratory tract infection, antibiotic dosing optimization, expert consensus recommendations, bacteriological response, clinical cure, pharmacokinetic/pharmacodynamic target attainment
- MeSH terms
- Anti-Bacterial Agents, beta-Lactamases, France, Glomerular Filtration Rate, Humans, Intensive Care Units, Serum Albumin, Societies, Medical, Societies, Pharmaceutical, Critical Illness, Treatment Outcome, Drug Monitoring, Guidelines as Topic, Drug Dosage Calculations
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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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