Abstract:
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 25 mg/kg and 20 mg/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%).
CONCLUSION : We observed numerous changes in practice since the ADMIN-ICU 2015 survey was conducted. Betalactams
are more commonly administered as extended infusions, and therapeutic drug monitoring use has increased,
which align with emerging evidence.
