الفهرس 
Pharmacology of Antibiotics and Modifications due to renal and liver diseaseOnly 14 pages are availabe for public view
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Abstract
Infections are an everyday problem in the intensive care unit (ICU) and antibiotics are therefore commonly used in this setting. Besides treatment of infections, antibiotics are administered as prophylaxis to prevent or limit major infections in critically ill patients. Thus, appropriate use of antibiotics in ICUs is important in ensuring an optimal clinical outcome, but also in controlling the emergence of resistance among pathogenic microorganisms and in decreasing costs.
The proper selection of antibiotics in ICU is one of the major tasks of the physician. Proper selection of antibiotics helps to rapidly control infection, prevent subsequent antibiotic resistance in cases of misuse. The proper selection mainly depends on the culture and sensitivity tests, but in cases of emergency in ICU, the empirical antibiotic use is the rule as there is no time to postpone the treatment until the results of culture become available. Empirical treatment is based on update data on trends of incidence and of susceptibility to antimicrobial agents in particular settings.
This empirical use of antibiotics in ICU contributes to the major problem of antibiotic resistance, thus, several policies of antibiotic use are in current use.
The aim of different antibiotic policies is to decrease the misuse of antibiotics, decrease the antibiotic resistance and avoid side of effects of such antibiotics.
The critically ill patients in ICUs represent challenges for the physician during prescribing antibiotics and needs special treatment. Another important group of patients includes those with renal or liver impairment. As antibiotics mostly metabolized in the liver and excreted through the kidneys, it is most important to adjust dose of antibiotics in such situations.
Appropriate use of antimicrobial agents involves obtaining an accurate diagnosis, determining the need for and timing of antimicrobial therapy, understanding how dosing affects the antimicrobial activities of different agents, tailoring treatment to host characteristics, using the narrowest spectrum and shortest duration of therapy, and switching to oral agents as soon as possible. In addition, non antimicrobial interventions, such as abscess drainage, are equally or more important in some cases and should be pursued diligently in comprehensive infectious disease management.
The most common ICU infections are pneumonia, bloodstream infection, and urinary tract infection, most of which are device related. Surgical site infection is common in surgical ICUs.
Hospital-acquired pneumonia (HAP), ventilator-associated pneumonia (VAP), and healthcare-associated pneumonia (HCAP) remain important causes of morbidity and mortality despite advances in antimicrobial therapy, better supportive care modalities, and the use of a wide-range of preventive measures.
In order to improve the standard of care offered to patients with sepsis, the Society of Critical Care Medicine, the European Intensive Care Society and the International Sepsis Forum launched the Surviving Sepsis Campaign (SSC) with a founding statement that became known as the ‘Barcelona declaration’. All aspects of management of the patient with severe sepsis were covered and recommendations or bundles, depending on the available level of evidence, were developed for each category.
UTIs are the most common of all infections and can occur at any time in the life of an individual. Antibiotics are the mainstay treatment for all UTIs. A variety of antibiotics are available and choices depend on many factors, including whether the infection is complicated or uncomplicated or primary or recurrent.