Empiric Antibiotics and Dosing in the Critically Ill: A Practical Review

This narrative review consolidates empiric selection logic, multidrug-resistant organism risk stratification, and altered pharmacokinetic/pharmacodynamic dosing for ICU pharmacists managing high-mortality infection.

piperacillin-tazobactamcefepimevancomycinbeta-lactamscarbapenemslinezoliddaptomycinechinocandinssepsisseptic shockMRSAESBLCREpharmacokineticsCRRTECMOantimicrobial stewardshipnarrative reviewICU Critical Care / ICU

Background Information

ICU infections demand precise antimicrobial strategies to reduce mortality risk.

Critically ill patients are at high risk for mortality due to infections compounded by antimicrobial resistance and altered pharmacokinetics. Effective antimicrobial management depends on microbiologic diagnostics, patient-specific factors, and local resistance patterns. Understanding pharmacokinetics in critically ill patients is key in selecting and dosing antimicrobials appropriately. Highlights the importance of tailored therapy in ICU settings. Balancing early appropriate therapy with resistance and toxicity risk is vital in the ICU.

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Authors: Gillett EM, Dube KM, Rhee C

Citation: Gillett EM, Dube KM, Rhee C Antibiotic Considerations in the Critically Ill: Empiric Choices and Dosing. Critical care clinics. 2026;42(3):585-609. doi:10.1016/j.ccc.2026.01.003

Article Links: PubMed · Journal / DOI

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Executive Summary

Study Design

Patient Population

Primary Outcomes

Secondary Outcomes & Safety Profile

Pharmacist Implications

Clinical Pearls

Limitations

Controversies & Evidence Gaps

Cost & Logistics

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