How to Treat Sepsis in the Background of Resistance?: Role of Pharmacodynamics / Pharmacokinetics in Treating Sepsis

• Published in: Indian journal of pediatrics Vol. 87; no. 2; pp. 111 - 116
• Main Authors: Agrawal, Mohit, Rattan, Ashok
• Format: Journal Article
• Language: English
• Published: New Delhi Springer India 01.02.2020
• Subjects: Age Factors; Anti-Bacterial Agents - pharmacology; Anti-Bacterial Agents - therapeutic use; Bacteria - drug effects; Bacterial Infections - drug therapy; Body Size; Drug Resistance, Microbial - drug effects; Gynecology; Humans; Infant; Infant, Newborn; Medicine; Medicine & Public Health; Microbial Sensitivity Tests; Pediatrics; Review Article; Sepsis - drug therapy; Sepsis - microbiology; Pharmacodynamic; Concentration dependent killing; Pediatric sepsis; Pharmacokinetic; Minimum inhibitory concentration; Time dependent killing
• ISSN: 0019-5456; 0973-7693
• DOI: 10.1007/s12098-019-03153-6

Though a decline has been seen in child mortality and morbidity over the last decades, sepsis in neonates and infants remains a major cause of death. Optimal use of antibiotics in sepsis management is a key factor which can further reduce the number of poor clinical outcomes. Selecting the right antibiotic to which the offending bacteria is susceptible and administrating the antibiotic within the first hour can save many lives. However, the pharmacokinetic profile of an antibiotic is affected by developmental changes such as capacity of drug metabolizing enzymes and maturation of organ function. This can affect antibiotic exposure and response in neonates and infants. While suspecting sepsis, the primary focus of empiric treatment during the initial phase is to assure efficacy and it must be broad based to cover all suspected pathogens. Once the bacterial etiology is confirmed as a cause of sepsis and the in vitro antibiotic susceptibility is established, targeted treatment can be started which ensures optimal balance between efficacy and safety.