PMID- 21118912
OWN - NLM
STAT- MEDLINE
DCOM- 20111004
LR  - 20110311
IS  - 1460-2091 (Electronic)
IS  - 0305-7453 (Linking)
VI  - 66
IP  - 2
DP  - 2011 Feb
TI  - Monte Carlo simulations: maximizing antibiotic pharmacokinetic data to optimize 
      clinical practice for critically ill patients.
PG  - 227-31
LID - 10.1093/jac/dkq449 [doi]
AB  - Infections in critically ill patients continue to result in unacceptably high 
      morbidity and mortality. Although few data exist for correlating antibiotic 
      exposure with outcome, antibiotic dosing is likely to be highly important for 
      maximizing resolution of infection in many patients. The practical and financial 
      difficulties of performing pharmacokinetic (PK) studies in critically ill 
      patients mean that analyses to maximize data such as Monte Carlo simulation (MCS) 
      are highly valuable. MCS uses computer software to perform virtual clinical 
      trials. The building blocks for MCS are: firstly, a robust population PK model 
      from the patient population of interest; secondly, descriptors of the effect of 
      covariates that influence the PK parameters; thirdly, description of the 
      susceptibility of bacteria to the antibiotic and finally a PK/pharmacodynamic 
      (PD) target associated with antibiotic efficacy. Probability of target attainment 
      (PTA) outputs can then be generated that describe the proportion of patients that 
      will achieve a pre-specified PD target for an MIC distribution. Such analyses can 
      then inform dosing requirements, which can be used to have a high likelihood of 
      achieving PK/PD targets for organisms with different MICs. In this issue of JAC, 
      Zelenitsky et al. provide a very useful example of MCS for interpreting the 
      optimal methods for dosing meropenem, piperacillin/tazobactam, cefepime and 
      ceftobiprole in critically ill patients.
FAU - Roberts, Jason A
AU  - Roberts JA
AD  - Burns, Trauma and Critical Care Research Centre, The University of Queensland, 
      Brisbane, Australia.
FAU - Kirkpatrick, Carl M J
AU  - Kirkpatrick CM
FAU - Lipman, Jeffrey
AU  - Lipman J
LA  - eng
PT  - Journal Article
DEP - 20101130
PL  - England
TA  - J Antimicrob Chemother
JT  - The Journal of antimicrobial chemotherapy
JID - 7513617
RN  - 0 (Anti-Bacterial Agents)
RN  - 0 (Biomarkers, Pharmacological)
SB  - IM
MH  - Anti-Bacterial Agents/administration & 
      dosage/economics/*pharmacokinetics/therapeutic use
MH  - Biomarkers, Pharmacological/analysis
MH  - *Critical Care
MH  - Critical Illness/mortality/*therapy
MH  - Humans
MH  - Microbial Sensitivity Tests
MH  - Monte Carlo Method
MH  - Treatment Outcome
EDAT- 2010/12/02 06:00
MHDA- 2011/10/05 06:00
CRDT- 2010/12/02 06:00
PHST- 2010/12/02 06:00 [entrez]
PHST- 2010/12/02 06:00 [pubmed]
PHST- 2011/10/05 06:00 [medline]
AID - dkq449 [pii]
AID - 10.1093/jac/dkq449 [doi]
PST - ppublish
SO  - J Antimicrob Chemother. 2011 Feb;66(2):227-31. doi: 10.1093/jac/dkq449. Epub 2010 
      Nov 30.