Search

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 25mg/kg and 20mg/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.

Additional file 1. Supplementary Material, Description of data: Table S1. Definition of infusion types and duration; Table S2. Online survey questions; Table S3. Exclusions; Table S4. Respondents as per Region and Economy; Table S5. Results according to Region and Economy; Table S6. TDM utilization and beta-lactam prolonged infusion administration according to hospital type.

The number of new cases of HIV infection has been steadily increasing. In the world scenario, there is an increase in access to antiretroviral therapy and, currently, 26 million people use antiretrovirals. In Brazil, a country that provides full and free access to antiretrovirals, about 630 thousand people are undergoing treatment. This study aims to describe the pharmacokinetic changes of antiretrovirals in patients with different physiological conditions. A bibliographic survey was carried out with studies related to the use of antiretrovirals in specific groups: extremes of age (newborns and elderly), pregnancy, liver diseases, chronic kidney disease, cardiovascular disease, obesity and metabolic disorders, dietary interactions, use and abuse of legal and illegal drugs and genetic polymorphism. In certain situations, changes in pharmacokinetic parameters such as absorption, distribution, metabolism and excretion were observed, as well as variations in plasma levels of antiretrovirals. In the investigated groups, the importance of dose adjustment is highlighted to increase the effectiveness of antiretrovirals, aiming to provide a more adequate treatment to people living with HIV. El número de nuevos casos de infección por el VIH ha aumentado continuamente. En el escenario mundial, hay una expansión del acceso a la terapia antirretroviral y, en la actualidad, 26 millones de personas usan antirretrovirales. En Brasil, un país que brinda acceso pleno y gratuito a los medicamentos antirretrovirales, alrededor de 630 mil personas están en tratamiento. Este estudio tiene como objetivo describir los cambios farmacocinéticos de los fármacos antirretrovirales en pacientes con diferentes condiciones fisiológicas. Se realizó un relevamiento bibliográfico con estudios sobre el uso de antirretrovirales en grupos específicos: extremos de edad (recién nacidos y ancianos), embarazo, enfermedad hepática, enfermedad renal crónica, enfermedad cardiovascular, obesidad, alteraciones metabólicas, interacciones alimentarias, uso y abuso de Drogas legales e ilegales y polimorfismo genético. En determinadas situaciones, se produjeron cambios en parámetros farmacocinéticos como absorción, distribución, metabolismo y excreción, así como variaciones en los niveles plasmáticos de antirretrovirales. En los grupos investigados, se destaca la importancia del ajuste de dosis para aumentar la eficacia de los antirretrovirales y proporcionar un tratamiento más apropiado para las personas que viven con el VIH. O número de novos casos de infecção pelo HIV tem aumentado continuamente. No cenário mundial, nota-se a ampliação do acesso à terapia antirretroviral e, atualmente, 26 milhões de pessoas fazem uso de antirretrovirais. No Brasil, país que fornece acesso integral e gratuito aos antirretrovirais, cerca de 630 mil pessoas encontram-se em tratamento. O presente estudo tem o objetivo de descrever as alterações farmacocinéticas dos antirretrovirais em pacientes com condições fisiológicas distintas. Realizou-se um levantamento bibliográfico com estudos relativos ao uso de antirretrovirais em grupos específicos: extremos de idade (recém-nascidos e idosos), gravidez, doença hepática, doença renal crônica, doença cardiovascular, obesidade, alterações metabólicas, interações alimentares, uso e abuso de drogas lícitas e ilícitas e polimorfismo genético. Em determinadas situações, verificou-se alterações em parâmetros farmacocinéticos como absorção, distribuição, metabolismo e excreção, assim como, variações dos níveis plasmáticos dos antirretrovirais. Destaca-se nos grupos investigados, a importância do ajuste de dose para aumentar a efetividade dos antirretrovirais e proporcionar um tratamento mais adequado às pessoas vivendo com HIV.