Pharmacokinetic/Pharmacodynamic Optimization and Therapeutic Drug Monitoring of Beta-Lactam Antibiotics in Abdominal Sepsis: Current Evidence, Challenges, and Clinical Perspectives—A Narrative Review

Background

Abdominal sepsis is associated with profound pharmacokinetic (PK) alterations that make standard beta-lactam dosing regimens potentially inadequate in critically ill patients. Increased volume of distribution, hypoalbuminemia, augmented renal clearance (ARC), acute kidney injury (AKI) and the PK complexity of the peritoneal compartment collectively impair the ability of conventional dosing to achieve pharmacodynamic (PD) targets. These PK derangements are clinically relevant but incompletely characterized in intra-abdominal infections (IAI)- specific cohorts, as most available data derive from broader critically ill populations. Beta-lactam antibiotics, the cornerstone therapy in IAIs, are particularly susceptible to these alterations, especially in the context of multidrug-resistant (MDR) pathogens.