Clinically relevant pharmacokinetic knowledge on antibiotic dosing among intensive care professionals is insufficient: a cross-sectional study

Fleuren, Lucas M.; Roggeveen, Luca F.; Guo, Tingjie; Waldauf, Petr; van der Voort, Peter H. J.; Bosman, Rob J.; Swart, Eleonora L.; Girbes, Armand R. J.; Elbers, Paul W. G.

doi:10.1186/s13054-019-2438-1

Critical Care

Table 2 Questions and model answers with their respective Angoff scores and clinical relevance

From: Clinically relevant pharmacokinetic knowledge on antibiotic dosing among intensive care professionals is insufficient: a cross-sectional study

	Question	Answer	Angoff score^a	Clinical relevance^a	Pass intensivists (%)
1	Are these antibiotics lipophilic or hydrophilic?
	Vancomycin	Hydrophilic	64	74	60.2
	Ceftriaxone	Hydrophilic	64	74	44.6
	Meropenem	Hydrophilic	64	74	49.1
	Ciprofloxacin	Lipophilic	64	74	37.2
2	Which antibiotic is barely protein-bound?	Meropenem	42	71	14.6
3	For which antibiotic, using continuous infusion, is a loading dose least (!) important	Meropenem	49	83	18.3
4	In case of severe renal dysfunction, how should the maintenance dose be adapted for these antibiotics?
	Vancomycin	Lower the dose^b	74	94	98.2
	Ceftriaxone	Lower the dose^b	68	94	96.0
	Meropenem	Lower the dose^b	72	94	90.0
	Ciprofloxacin	Lower the dose^b	70	94	70.4
5	In case of severe renal dysfunction, how should the initial dose be adapted for these antibiotics?
	Vancomycin	No adaptation	75	93	65.5
	Ceftriaxone	No adaptation	72	93	85.0
	Meropenem	No adaptation	74	93	64.1
	Ciprofloxacin	No adaptation	74	93	66.9
6	Which treatment goal is most relevant for these antibiotics?
	Vancomycin	AUC_0–24/MIC	57	87	31.8
	Ceftriaxone	T > MIC	60	87	45.2
	Meropenem	T > MIC	60	87	49.9
	Ciprofloxacin	AUC0-24/MIC	54	87	31.6
7	How are these antibiotics cleared?
	Vancomycin	Mostly renally	64	89	90.0
	Ceftriaxone	Both renally and via liver/bile/feces	59	89	31.0
	Meropenem	Mostly renally	60	89	48.8
	Ciprofloxacin	Both renally and via liver/bile/feces	60	89	30.7
8	What are risk factors for augmented renal clearance?
	Cardiac arrest	False	66	87	82.1
	Prolonged ICU admittance	False	65	87	73.3
	Advanced age	False	65	87	78.8
	Multi-trauma	True	65	87	47.6
	Limited comorbidity	True	65	87	33.1
9	How do these parameters change in the initial phase of septic shock following adequate volume resuscitation?
	Volume of distribution	Increases	61	85	87.1
	Clearance	Increases	61	85	35.5
10	The volume of distribution of an antibiotic is 100 L. Clearance is 10 L/h. What is the half-life?	About 7 h	50	56	41.6
11	What happens to half-life if …
	Clearance increases	Decreases	64	70	88.9
	Clearance decreases	Increases	65	70	89.8
	Volume of distribution increases	Increases	63	70	40.5
	Volume of distribution decreases	Decreases	63	70	39.4
12	The half-life of an antibiotic is 3 h. When is steady state reached approximately following start of continuous infusion?	13–17 h	49	49	38.8

^aScore out of 100
^bMultiple answers can be correct; see Box 1

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