Current Dosing Recommendations for Beta Lactams: Addressing the Challenges

Jason M. Pogue, PharmD, clinical assistant professor of Medicine at Wayne State University School of Medicine discusses the challenges clinicians face when dosing beta-lactams based on the current guidelines.

Interview transcript (modified slightly for readability):

I think the biggest challenges that we deal with, is that, particularly for our older beta-lactam agents, the doses are kind of historic. They are kind of ancient in a lot of ways. They came to market at a time where pharmacodynamic dose optimization was not done the way it is today. They were studied in healthier individuals and less severe disease states, and we simply live in a different world today.

We live in a world that has higher MIC values, and we are dealing with much sicker patient populations. There is huge inner patient variability from the pharmacokinetics within a given patient from that standpoint. Even though we think PK/PD is very advanced and we really know what we’re targeting, there are certainly some conflicting data about what the optimal targets are in our patients. There is also the concern that if you give a lower dose, which a lot of the time is what’s going on, you really set your patient up for the development of drug resistance.

We live in a day and age where one of the biggest things we try to do as stewards is dose-optimize antimicrobials and, unfortunately, a lot of those doses are extremely outdated and probably inappropriate for a large number of our patients.