Table 1.
Summary of Recommendations in Critically Ill Patients Based on Available Evidence.
| Drug | Suggested Measures | Suggestion Basis |
|---|---|---|
| Antiepileptic Drugs | ||
| Phenytoin | •Oral administration: Hold TF for 1-2 hours before and after drug administration •TDM is important •Parenteral formulation is available |
Moderate evidence •Four studies: Three observational; one interventional Four case reports •Three studies had sample sizes ≥20 participants6-10,78,79 |
| Valproic acid | •Oral administration: No dose increase required •Parenteral formulation is available |
Very low evidence •One observational study •Sample size ≥20 participants 12 |
| Levetiracetam | •Oral administration: Consider using higher doses •Parenteral formulation is available |
Very low evidence •One observational study •Sample size ≥20 participants 12 |
| Carbamazepine | •Oral administration of suspension in pediatrics: No dose increase required •Avoid co-administration of TF if the effect is desired to come quickly |
Very low evidence •One observational study •Sample size ≤20 participants 15 |
| Phenobarbital | •Oral administration after switch from parenteral route in neonates: Higher doses might be required •TDM is important •Parenteral formulation is available |
Very low evidence •Two observational studies •Both studies had sample sizes ≥20 participants13,14 |
| Antimicrobials | ||
| Ciprofloxacin | •Unfunctional GI tract or unsure: Use parenteral administration •functional GI tract: Oral administration: Consider higher doses •Parenteral formulation is available | Moderate evidence •Six studies: Five observational, one interventional •One study had a sample size ≥2018-21,80,81 |
| Moxifloxacin | •Prefer parenteral administration | Very low evidence •Two observational studies •One study had a sample size ≥2022,23 |
| Cefroxadine | •Oral administration: Consider higher doses | Very low evidence •One observational study •Sample size ≥20 participants 27 |
| Gatifloxacin | •Oral administration: Highly variable; consider injectable formulation | Very low evidence •One observational study •Sample size ≤20 participants 25 |
| Levofloxacin | •Oral administration: No dose increase required | Very low evidence •One observational study •Sample size ≤20 participants 24 |
| Trimetoprim-sulfamethoxazole | •Oral administration: No dose increase required | Very low evidence •One observational study •Sample size ≤20 participants 28 |
| Antifungals | ||
| Fluconazole | •Oral administration: Consider higher doses | Moderate evidence •Six studies: Four observational, two interventional •One study had sample size ≥20 participants30,32,34-37 |
| Posaconazole | •Parenteral administration preferred •If oral administration used, avoidance of PPI therapy and holding TF may be required |
Moderate evidence •Adults; two studies: One observational, one interventional •Pediatrics; one case report •One study had sample size ≥20 participants38,39,82 |
| Itraconazole | •Oral administration: Consider higher doses avoid co-administration of PPI | Very low evidence •One case report 40 |
| Voriconazole | •Oral administration: Consider higher doses; continuous TF may be appropriate •TDM is available |
Very low evidence •One observational study •Sample size ≤20 participants 41 |
| Gastric acid suppressing medications | ||
| Lansoprazole | •Acid suppression is unaffected •Oral administration: No dose increase required |
Moderate evidence •One interventional study •Sample size ≤20 participants 42 |
| Pirenzepine | •Acid suppression is unaffected •Oral administration: No dose increase required |
Very low evidence •One observational study •Sample size ≥20 participants 43 |
| Ranitidine | •Oral administration: No dose increase required | Moderate evidence •One interventional study •Sample sizes ≤20 participants 44 |
| Cardiovascular medications | ||
| Verapamil | •Bioavailability appeared to be slightly reduced •Oral administration: No dose increase required |
Very low evidence •One observational study •Sample size ≤20 participants 45 |
| Acetylsalicylic acid | •Antiplatelet effect is unaffected •Oral administration: No dose increase required |
Moderate evidence •One interventional study •Sample size ≥20 participants 46 |
| Clopidogrel | •Stable patients: Oral administration: No dose increase required •Unstable patients after CPR and acute PCI: Oral administration: antiplatelet effect might be impaired |
Very low evidence •One observational study •Sample size ≤20 participants 47 |
| Clonidine | •Delayed absorption in postoperative cardiac pediatric patients •Oral administration:no dose increase required |
Very low evidence •One observational study •Sample size ≤20 participants 48 |
| Other medications | ||
| Melatonin | •Oral administration: Start dosing at low doses and titrate as needed | Moderate evidence •Four interventional studies •Two studies had sample sizes ≥2049-52 |
| Tacrolimus | •Oral administration in transplant patients: No dose increase required; continuous TF may be used •TDM is available | Very low evidence •One observational study •Sample size ≤20 participants 62 |
| Fludrocortisone | •Stable patients: Oral administration: No dose increase required •Unstable patients: Consider use of an alternate agent |
Very low evidence •One observational study •Sample size ≥20 participants 53 |
| Acetaminophen | •Adults: Oral administration: No dose increase required; Parenteral administration preferred if delayed gastric emptying expected (e.g., post-operative patients) •Pediatrics: No dose increase required; Parenteral administration preferred if delayed gastric emptying expected |
Very low evidence •Adults; two observational studies •Pediatrics; one observational study •One study had sample size ≥20 participants56-58 |
| Metformin | •Glycemic control is unaffected •Oral administration: No dose increase required |
Moderate evidence •One interventional study •Sample size ≥20 participants 61 |
| Aminophylline | •Oral administration: No dose increase required | Very low evidence •One observational study •Sample size ≤20 participants 65 |
| Thyroxine (T4) | •Oral administration: No dose increase required | Moderate evidence •One interventional study •Sample size ≥20 participants 66 |
| Oseltamivir | •Oral administration: No dose increase required | Very low evidence •Two observational studies; one case report •All studies had sample sizes ≤20 participants67-69 |
| Potassium chloride | •Oral administration: No dose increase required | Very low evidence •One observational study •Sample size ≥20 participants 70 |
BID, twice a day; CPR, cardiopulmonary resuscitation; F, bioavailability; PCI, percutaneous coronary intervention; PO, per oral; TDM, therapeutic drug monitoring; TF, tube feeding.