Lea Marie Schatz1, Michael Zoller2, Christina Scharf2, Uwe Liebchen3. 1. Institut für Klinische Pharmazie, Westfälische Wilhelms-Universität Münster, Münster, Deutschland. 2. Klinik für Anästhesiologie, LMU Klinikum, Marchioninistr. 15, 81377, München, Deutschland. 3. Klinik für Anästhesiologie, LMU Klinikum, Marchioninistr. 15, 81377, München, Deutschland. uwe.liebchen@med.uni-muenchen.de.
Abstract
BACKGROUND AND OBJECTIVE: Antibiotic dosing in intensive care patients is complex due to pharmacokinetic (PK) alterations. The aim of this article is to illustrate the role of therapeutic drug monitoring (TDM) and PK models to individualize antibiotic dosing. MATERIAL AND METHODS: Guidelines and recommendations are discussed in the context of clinical practice and the prerequisites for routine TDM of different antibiotics are presented. In addition, the benefits and limitations of TDM are discussed. The advantages and disadvantages of TDM and PK models are described and the resulting future options are presented. RESULTS: In the clinical routine, the peak or trough concentrations of antibiotics in blood are measured depending on the antibiotic class. Prerequisites for a purposeful TDM are a coordinated blood sampling and a prompt reporting of findings. As target ranges are not uniformly defined following rules, dosage adjustments are difficult. The PK models offer a valid possibility to individualize the antibiotic therapy of intensive care patients. Areas of application are the calculation of the loading dose and the combination with TDM for treatment control. For whom and how often TDM is necessary and how it can best be combined with PK models or even replace them should be investigated in the future, in addition to evaluation of the optimal target area. CONCLUSION: The routine use of TDM for antibiotics in intensive care patients is only effective under the abovementioned conditions. By combination with PK models the treatment could be optimized in the future.
BACKGROUND AND OBJECTIVE: Antibiotic dosing in intensive care patients is complex due to pharmacokinetic (PK) alterations. The aim of this article is to illustrate the role of therapeutic drug monitoring (TDM) and PK models to individualize antibiotic dosing. MATERIAL AND METHODS: Guidelines and recommendations are discussed in the context of clinical practice and the prerequisites for routine TDM of different antibiotics are presented. In addition, the benefits and limitations of TDM are discussed. The advantages and disadvantages of TDM and PK models are described and the resulting future options are presented. RESULTS: In the clinical routine, the peak or trough concentrations of antibiotics in blood are measured depending on the antibiotic class. Prerequisites for a purposeful TDM are a coordinated blood sampling and a prompt reporting of findings. As target ranges are not uniformly defined following rules, dosage adjustments are difficult. The PK models offer a valid possibility to individualize the antibiotic therapy of intensive care patients. Areas of application are the calculation of the loading dose and the combination with TDM for treatment control. For whom and how often TDM is necessary and how it can best be combined with PK models or even replace them should be investigated in the future, in addition to evaluation of the optimal target area. CONCLUSION: The routine use of TDM for antibiotics in intensive care patients is only effective under the abovementioned conditions. By combination with PK models the treatment could be optimized in the future.
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Authors: Mohd H Abdul-Aziz; Jan-Willem C Alffenaar; Matteo Bassetti; Hendrik Bracht; George Dimopoulos; Deborah Marriott; Michael N Neely; Jose-Artur Paiva; Federico Pea; Fredrik Sjovall; Jean F Timsit; Andrew A Udy; Sebastian G Wicha; Markus Zeitlinger; Jan J De Waele; Jason A Roberts Journal: Intensive Care Med Date: 2020-05-07 Impact factor: 17.440
Authors: Lisa Ehmann; Michael Zoller; Iris K Minichmayr; Christina Scharf; Barbara Maier; Maximilian V Schmitt; Niklas Hartung; Wilhelm Huisinga; Michael Vogeser; Lorenz Frey; Johannes Zander; Charlotte Kloft Journal: Crit Care Date: 2017-10-21 Impact factor: 9.097