Improving antibiotic use for critical care

Professor Jeremy Lipman

Professor Jeremy Lipman is the Centre’s executive director and Director of Intensive Care Services at Royal Brisbane and Women’s Hospital (RBWH), where the
centre is based. RBWH staff are major contributors to the research centre, instituting a large number of studies to improve the treatment and outcomes of patients with the thermal injuries, including post burn exercise and antibiotic efficacy.

Professor Lipman’s pioneering research has found that patients in intensive care require higher doses of antibiotics to kill pathogens than other patients.
“I am very proud of the whole team. Not only are we one of the most productive ICUs in the world from a research point of view, we are clinically making a difference to how ICU patients are getting treated, particularly in relation to antibiotic prescribing,” Prof Lipman says.

Building on and complementing such discoveries is the Centre of Research Excellence in Redefining Antimicrobial Use to Reduce Resistance (CRE REDUCE), led by RBWH Consultant Clinical Pharmacist Professor Jason Roberts. Prof Lipman is also a chief investigator with CRE REDUCE.

The centre is designed to provide support for teams of researchers to pursue collaborative research and develop capacity in clinical, population health and
health services research. A significant piece of work was the BLING III study, comparing continuous dosing and daily dosing of beta lactam antibiotics. This worldwide 7000 patient study, in partnership with the George Institute in Sydney, is building on Prof Lipman’s previous findings that a single large dose of aminoglyocides (a different class of antibiotics) is more effective than the manufacturer’s recommended dosing. The challenge for critical care comes from the clinical trial process – if the drug is found to beneficial for non-critically ill humans, the recommended dose is based on those tests.

“That’s not the same for ICU. The doses need to be totally different,” says Prof Lipman. Over the past decade, he has researched this ‘off
label’ use of antibiotics for critical patients. He hopes this common ICU evidence-based practice may transfer to other wards and reduce the potential for
antibiotic resistance.

Professor Jason Roberts says that’s a critical purpose of the CRE REDUCE, which aims to develop global capacity in antimicrobial resistance research by
fostering post-graduate and post-doctoral fellow research, teaching undergraduate students and training healthcare practitioners.

“The main goals of the centre, and the projects, are to better understand exposure-related antimicrobial resistance and formulation, clinical testing of newly
established dosing regimens in order to optimise in vivo antimicrobial activity, and, ultimately, to improve patient outcomes,” Prof Roberts said.

“Antimicrobial resistance is a major global challenge and likely to remain so for some time.”