ReviewCritical care explorations2021
Setting the Beta-Lactam Therapeutic Range for Critically Ill Patients: Is There a Floor or Even a Ceiling?
Review in Critical care explorations, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 48 papers, 1 of them a synthesis that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
48 citing papers in PubMed, 1 synthesis or guideline pooled it, 74 citations in OpenAlex.
- Therapeutic drug monitoring and the role of pharmacokinetics/pharmacodynamics in optimizing beta-lactam antibiotic dosing for deep-seated infections: a systematic review.The Journal of antimicrobial chemotherapy · 2026Pooled it
- Achieving target plasma concentrations of beta-lactam antibiotics in critically ill patients: a retrospective study of full-dose administration in the first 24 hours.Pharmacological reports : PR · 2026Observational
- Examining the risk of neurotoxicity in patients who receive unadjusted doses of oral beta-lactams in renal insufficiency: a retrospective cohort study.European journal of clinical pharmacology · 2026Article
- Pharmacokinetics/pharmacodynamics of ceftazidime-avibactam in critically ill adult patients receiving continuous renal replacement therapy.Antimicrobial agents and chemotherapy · 2026Article
- β-Lactam dosing in critically ill children: predictors for target non-attainment.The Journal of antimicrobial chemotherapy · 2026Observational
- Population Pharmacokinetics and Dosing Regimen Optimization of Piperacillin in Critically Ill Patients.Drug design, development and therapy · 2026Article
- Low Target Attainment of Intravenous Cefuroxime in Critically Ill Term Neonates and Children: A Pooled Population Pharmacokinetics Study.Clinical pharmacokinetics · 2026Article
- Impact of Extending Beta-Lactam Infusions on IV Access Requirements.Critical care explorations · 2025Article
- Evaluation of amoxicillin and benzylpenicillin therapy in early-onset neonatal sepsis: a pharmacometric external validation and simulation study.The Journal of antimicrobial chemotherapy · 2025Article
- The Effect of Antibiotics on the Nervous System: Importance for Anesthesiology and Intensive Care.Antibiotics (Basel, Switzerland) · 2025Review
- Feasibility of 24 h continuous-infusion cefiderocol administered by elastomeric pump in attaining an aggressive PK/PD target in the treatment of NDM-producingJAC-antimicrobial resistance · 2025Article
- Cystatin C-Guided Dosing Nomogram Improves Target Attainment for Cefepime in the Critically Ill.Critical care medicine · 2025Article
- Urinary Biomarkers and Attainment of Cefepime Therapeutic Targets in Critically Ill Children.The Pediatric infectious disease journal · 2025Observational
- Enhancing antibiotic therapy through comprehensive pharmacokinetic/pharmacodynamic principles.Frontiers in cellular and infection microbiology · 2025Review
- Pharmacodynamics of piperacillin/tazobactam againstJAC-antimicrobial resistance · 2024Article
- Use of the DMAIC Lean Six Sigma quality improvement framework to improve beta-lactam antibiotic adequacy in the critically ill.International journal for quality in health care : journal of the International Society for Quality in Health Care · 2024Article
- Ceftazidime-related neurotoxicity in a patient with renal impairment: a case report and literature review.Infection · 2024Review
- Piperacillin pharmacokinetics and pharmacodynamics in paediatric patients who received high frequency intra-operative piperacillin/tazobactam dosing.International journal of antimicrobial agents · 2024Article
- The OPAT opportunity for beta-lactam individualization.Antimicrobial stewardship & healthcare epidemiology : ASHE · 2024Article
- Ten reasons for the presence of pharmacy professionals in the intensive care unit.Intensive care medicine · 2024Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
6 authors at 3 institutions in 1 country.
Funding
Abstract
Beta-lactam antibiotics exhibit high interindividual variability in drug concentrations in patients with critical illness which led to an interest in the use of therapeutic drug monitoring to improve effectiveness and safety. To implement therapeutic drug monitoring, it is necessary to define the beta-lactam therapeutic range-in essence, what drug concentration would prompt a clinician to make dose adjustments up or down. This objective of this narrative review was to summarize evidence for the "floor" (for effectiveness) and "ceiling" (for toxicity) for the beta-lactam therapeutic range to be used with individualized therapeutic drug monitoring. DATA SOURCES: Research articles were sourced from PubMed using search term combinations of "pharmacokinetics," "pharmacodynamics," "toxicity," "neurotoxicity," "therapeutic drug monitoring," "beta-lactam," "cefepime," "meropenem," "piperacillin/tazobactam," "ICU," and "critical illness." STUDY SELECTION: Articles were selected if they included preclinical, translational, or clinical data on pharmacokinetic and pharmacodynamic thresholds for effectiveness and safety for beta-lactams in critical illness. DATA SYNTHESIS: Experimental data indicate a beta-lactam concentration above the minimum inhibitory concentration of the organism for greater than or equal to 40-60% of the dosing interval is needed, but clinical data indicate that higher concentrations may be preferrable. In the first 48 hours of critical illness, a free beta-lactam concentration at or above the susceptibility breakpoint of the most likely pathogen for 100% of the dosing interval would be reasonable (typically based on
conclusionsAs studies advance the understanding of beta-lactam exposure and response in critically ill patients, it is essential to clearly define the acceptable therapeutic range to guide regimen selection and adjustment.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.