Abdul–Aziz MH, et al. – The purpose of this review was to describe the recent pharmacokinetic/pharmacodynamic data relevant to antibiotic dosing for nosocomial pneumonia caused by multidrug–resistant pathogens. Findings reveal that conventional antibiotic dosing increases the likelihood of therapeutic failure in these critically ill patients. The authors recommend considering alternative dosing strategies, which exploit the pharmacokinetic/pharmacodynamic properties of an antibiotic to ensure optimal antibiotic exposure and better therapeutic outcomes in these patients.

• In critically ill patients with nosocomial pneumonia, optimal antibiotic treatment is challenging.
• It was noticed that most dosing guidelines do not consider the altered physiology and illness severity associated with severe lung infections
• Findings suggest that plasma drug concentrations can guide antibiotic dosing, these do not reflect the concentrations at the site of infection.
• To ensure rapid and effective drug exposure in infected lung tissues, it seems that the application of aggressive dosing regimens, in accordance to the antibiotic's pharmacokinetic/pharmacodynamic characteristics, is required.