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Funds for antibiotics study on ICU

Can antibiotics treatment be better tailored towards individual patients for faster discharge from the ICU?

subsidie antibioticastudie IC volwassenen

The Hospital Pharmacy, the ICU for adults, and the Medical Microbiology and Infectious Diseases department received a grant of € 500,000 from ZonMW (Netherlands Organisation for Health Research and Development) to conduct research on this topic.

"At the heart of the treatment of ICU patients with sepsis is antibiotics therapy, however, a necessary condition is that adequate antibiotic levels are achieved", explains Rik Endeman, intensivist and project leader.

Bloodstream
"But this is something that is difficult to achieve for ICU patients, as, by definition, they almost always have kidney and/or liver disorders. Drugs are often distributed differently in the bodies of ICU patients than in healthy people, and in addition, machines, such as dialysis equipment or heart-lung machines, are almost always connected to the patient's bloodstream. This makes it extremely difficult to achieve adequate antibiotic levels."

The current dosage of antibiotics is more or less the same for everyone, while every patient is different. "Most doses were determined a long time ago", explains co-leader of the project and hospital pharmacist Birgit Koch, "at a time when patients had less complex conditions, with less complex treatments. And bacteria still responded well to the drugs."

International studies and the EXPAT study carried out by Erasmus MC have shown that the current standard treatment is not sufficient for many patients. Endeman says "Inadequate treatment results in higher mortality rates on an ICU, longer mechanical ventilation, and also longer ICU and hospital stays."

Dolphin study
A total of 450 adult ICU patients are participating in this Dolphin study. They have been allocated in one of two research groups by drawing lots. One group receives the usual standard dosage. Therapeutic Drug Monitoring (TDM) is used for the other group, which means that shortly after the first day of receiving antibiotics the patient's blood is tested to determine whether the concentration of antibiotics is sufficient.

The Hospital Pharmacy has developed its own computer models and documents for these measurements. "If the test shows that it is not the optimum dose, the attending intensivist will be advised to adjust the dosage. The Medical Microbiology and Infectious Diseases department then monitors the effect of this change on the bacterial growth," says Endeman.

Koch says "Our first goal is to shorten the ICU stay, because the longer a patient stays on an ICU, the poorer the quality of life in the period afterwards. We are also going to check whether TDM-controlled dosages affect mortality. If the results are positive, Dutch hospitals will be able introduce the personalized doses in their ICUs.

Date published: 19 October 2018.

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