Personalized antimicrobial therapy in critical and elderly patients

Objective: Personalized therapy in the treatment of infections is essential to ensure optimization of antimicrobial drug levels. This strategy, together with an understanding of the activity of these drugs, decreases the risk of bacterial resistance and improves the drugs safety profile. Alternative routes of administration, such as inhalation, and tire information provided by pharmacokinetic models, are essential given the limitation of antimicrobial activity allowed by the new antimicrobials. Method: A non-systematic review of the literature is presented as a way of tackling and finding solutions to the problem. A search for high-quality articles on the research topic was conducted. Results: A total of 370 articles were detected, which were subjected to a further selection to discard low quality papers by a team of five clinical pharmacists and an intensivist. Finally, 153 articles were included in the review. Conclusions: The geriatric and the critical care patient population require the administration of antimicrobials with close monitorinr. The routes of administration recommended for the first group are discourraged for the second. The inhaled route often results in high plasma concentrations in patients with respiratory infections. Pharmacokinetic models are a valuable tool in the treatment of geriatric patients, who are often excluded from clinical trials.