A narrative review on antimicrobial dosing in adult critically ill patients on extracorporeal membrane oxygenation

Crit Care. 2024 Oct 4;28(1):326. doi: 10.1186/s13054-024-05101-z.

Abstract

The optimal dosing strategy of antimicrobial agents in critically ill patients receiving extracorporeal membrane oxygenation (ECMO) is unknown. We conducted comprehensive review of existing literature on effect of ECMO on pharmacokinetics and pharmacodynamics of antimicrobials, including antibacterials, antifungals, and antivirals that are commonly used in critically ill patients. We aim to provide practical guidance to clinicians on empiric dosing strategy for these patients. Finally, we discuss importance of therapeutic drug monitoring, limitations of current literature, and future research directions.

Keywords: Antimicrobial dosing; Extracorporeal membrane oxygenation; Pharmacokinetics; Therapeutic drug monitoring.

Publication types

  • Review

MeSH terms

  • Adult
  • Anti-Infective Agents* / administration & dosage
  • Anti-Infective Agents* / pharmacokinetics
  • Anti-Infective Agents* / therapeutic use
  • Critical Illness* / therapy
  • Extracorporeal Membrane Oxygenation* / methods
  • Humans

Substances

  • Anti-Infective Agents