The Effects of Hypoalbuminaemia on Optimizing Antibacterial Dosing in Critically Ill Patients

摘要: Low serum albumin levels are very common in critically ill patients, with reported incidences as high 40-50%. This condition appears to be associated alterations the degree of protein binding many highly protein-bound antibacterials, which lead altered pharmacokinetics and pharmacodynamics, although this topic is infrequently considered daily clinical practice. The effects hypoalbuminaemia on driven by decrease extent antibacterial bound albumin, increases unbound fraction drug. Unlike plasma proteins, only available for distribution clearance from (central compartment). Hence, likely increase apparent total volume (V(d)) (CL) a drug, would translate lower exposures that might compromise attainment pharmacodynamic targets, especially time-dependent antibacterials. effect concentrations also have an important impact but there little information area. objectives review were identify original research papers report variations (mainly V(d) CL) patients without renal failure, subsequently interpret consequences dosing. All relevant articles described and/or pharmacodynamics antibacterials conserved function reviewed. We found decreases presence frequently observed patients. For example, CL ceftriaxone (85-95% binding) hypoalbuminaemic increased 2-fold. A similar phenomenon was ertapenem binding), led failure attain targets (40% time concentration [free] maintained above minimal inhibitory [fT>MIC] bacteria throughout dosing interval). other such teicoplanin, aztreonam, fusidic acid or daptomycin among others significantly compared healthy subjects. Increased appeared most significant pharmacokinetic decreased binding, together CL. These changes may result achievement resulting sub-optimal treatment. concentration-dependent more controversial due lack data topic. In conclusion, antibacterial-albumin produce Dose adjustments these should regarded another step optimization. Moreover, some new development exhibit level rarely trials Further defines regimens account recommended.