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)

Abstract

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.

Electronic supplementary material

The online version of this article (10.1186/s13054-019-2378-9) contains supplementary material, which is available to authorized users.

Contributors

Romain Guilhaumou: [e-mail]

Sihem Benaboud: [e-mail]

Youssef Bennis: [e-mail]

Claire Dahyot-Fizelier: [e-mail]

Eric Dailly: [e-mail]

Peggy Gandia: [e-mail]

Sylvain Goutelle: [e-mail]

Sandrine Lefeuvre: [e-mail]

Nicolas Mongardon: [e-mail]

Claire Roger: [e-mail]

Julien Scala-Bertola: [e-mail]

Florian Lemaitre: [e-mail]

Marc Garnier:

ORCID: http://orcid.org/0000-0002-5716-4239

[phone] , [e-mail]

Journal

Journal ID (nlm-ta): Crit Care

Title: Critical Care

Publisher: BioMed Central (London )

ISSN (Print): 1364-8535

ISSN (Electronic): 1466-609X

Publication date (Electronic): 29 March 2019

Publication date PMC-release: 29 March 2019

Publication date Collection: 2019

Volume: 23

Affiliations

[1 ]ISNI 0000 0001 0407 1584, GRID grid.414336.7, AP-HM Hôpital de la Timone, Service de Pharmacologie Clinique et Pharmacovigilance, ; 264 rue Saint Pierre, 13005 Marseille, France

[2 ]AP-HP Hôpital Cochin, Service de Pharmacologie, 27 rue du Faubourg St-Jacques, 75679 Paris Cedex 14, France

[3 ]GRID grid.413858.3, CHU d’Amiens Picardie, Service de Pharmacologie Clinique, UPJV EA7517, ; Avenue Laennec, 80054 Amiens Cedex 1, France

[4 ]ISNI 0000 0000 9336 4276, GRID grid.411162.1, CHU de Poitiers, Département d’Anesthésie Réanimation, ; 2 Rue de la Milétrie, 86021 Poitiers, France

[5 ]ISNI 0000 0004 0472 0371, GRID grid.277151.7, CHU de Nantes, Département de Pharmacologie Clinique, ; 5 allée de l’île gloriette, 44093 Nantes Cedex 01, France

[6 ]ISNI 0000 0001 1457 2980, GRID grid.411175.7, CHU de Toulouse, Laboratoire de Pharmacocinétique et Toxicologie Clinique, Institut Fédératif de Biologie, ; 330, avenue de Grande-Bretagne, 31059 Toulouse cedex 9, France

[7 ]ISNI 0000 0001 2163 3825, GRID grid.413852.9, CHU de Lyon, Service de Pharmacie, Groupement Hospitalier Nord, Hôpital Pierre Garraud, ; 136 rue du Commandant Charcot, 69322 Lyon cedex 05, France

[8 ]ISNI 0000 0004 1792 201X, GRID grid.413932.e, CHR d’Orléans, Laboratoire de Biochimie, ; 14 Avenue de l’Hôpital, 45067 Orléans, France

[9 ]AP-HP Hôpital Henri Mondor, Département d’Anesthésie-Réanimation, 51 Avenue du Maréchal de Lattre de Tassigny, 94000 Créteil, France

[10 ]ISNI 0000 0004 0593 8241, GRID grid.411165.6, CHU de Nîmes, Département d’anesthésie, réanimation, douleur et médicine d’urgence, ; Place du Pr Robert Debré, 30029 Nîmes cedex 9, France

[11 ]ISNI 0000 0004 1765 1301, GRID grid.410527.5, CHRU de Nancy, Département de pharmacologie clinique et de toxicologie, ; 29 rue Lionnois, 54000 Nancy, France

[12 ]GRID grid.414271.5, CHU Pontchaillou, Service de Pharmacologie Clinique et épidémiologique, ; 2 Rue Henri le Guilloux, 35000 Rennes, France

[13 ]ISNI 0000 0001 2175 4109, GRID grid.50550.35, AP-HP Hôpital Tenon, Département d’Anesthésie et Réanimation, ; 4 rue de la Chine, 75020 Paris, France

Article

Publisher ID: 2378

DOI: 10.1186/s13054-019-2378-9

PMC ID: 6441232

PubMed ID: 30925922

Copyright statement: © The Author(s). 2019

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

Categories

Subject: Review

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