• Andrew A Udy, Jan J De Waele, and Jeffrey Lipman.
• Department of Intensive Care and Hyperbaric Medicine, The Alfred, Prahran, Melbourne 3181, VIC, Australia.
• Int. J. Antimicrob. Agents. 2015 Apr 1; 45 (4): 331-3.

AbstractSuccessful application of antibacterial therapy in the critically ill requires an appreciation of the complex interaction between the host, the causative pathogen and the chosen pharmaceutical. A pathophysiological change in the intensive care unit (ICU) patient challenging the 'one dose fits all' concept includes augmented renal clearance (ARC), defined as a creatinine clearance (CL(Cr)) of ≥130 mL/min. Ideally, CL(Cr) values should be obtained by a timed measured collection of urine, with plasma and urine creatinine levels. Increased renal clearance of antibiotics also occurs in the ICU patient and therefore β-lactam antibiotic exposure in the critically ill could easily lead to trough drug concentrations below therapeutic ranges. One way to document and alter drug levels is via therapeutic drug monitoring (TDM). The interactions of ARC and β-lactam TDM are further explored in this article in specific reference to a concomitant article in this issue of the journal.Copyright © 2015 Elsevier B.V. and the International Society of Chemotherapy. All rights reserved.

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