Anbx in sepsis

Q: In patients with septic shock antibiotics should be started at? (select one)

A) full "high-end" loading dose 
B) full "low-end" loading dose


Answer: A

In patients with septic shock, antibiotics should be started at a full "high-end" loading dose if there is no significant contra-indication. This is due to the reason that these patients usually have a increased volume of distribution that occurs due to the administration of intravenous fluid (IVF) resuscitation. Higher clinical success rates are reported with higher peak concentrations of different antibiotics in these patients.

#sepsis
#infectious-diseases
#pharmacology


References:

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2. van Zanten AR, Polderman KH, van Geijlswijk IM, et al. Ciprofloxacin pharmacokinetics in critically ill patients: a prospective cohort study. J Crit Care 2008; 23:422. 

3. Blot S, Koulenti D, Akova M, et al. Does contemporary vancomycin dosing achieve therapeutic targets in a heterogeneous clinical cohort of critically ill patients? Data from the multinational DALI study. Crit Care 2014; 18:R99. 

4. Zelenitsky S, Rubinstein E, Ariano R, et al. Vancomycin pharmacodynamics and survival in patients with methicillin-resistant Staphylococcus aureus-associated septic shock. Int J Antimicrob Agents 2013; 41:255. 

5. Preston SL, Drusano GL, Berman AL, et al. Pharmacodynamics of levofloxacin: a new paradigm for early clinical trials. JAMA 1998; 279:125. 

6. Kashuba AD, Nafziger AN, Drusano GL, Bertino JS Jr. Optimizing aminoglycoside therapy for nosocomial pneumonia caused by gram-negative bacteria. Antimicrob Agents Chemother 1999; 43:623.