Therapeutic drug monitoring of beta-lactam antibiotics in burns patients-A one-year prospective study

Patel, Bhavik M., Paratz, Jennifer, See, Natalie C., Muller, Michael J., Rudd, Michael, Paterson, David, Briscoe, Scott E., Ungerer, Jacobus, McWhinney, Brett C., Lipman, Jeffrey and Roberts, Jason A. (2012) Therapeutic drug monitoring of beta-lactam antibiotics in burns patients-A one-year prospective study. Therapeutic Drug Monitoring, 34 2: 160-164. doi:10.1097/FTD.0b013e31824981a6


Author Patel, Bhavik M.
Paratz, Jennifer
See, Natalie C.
Muller, Michael J.
Rudd, Michael
Paterson, David
Briscoe, Scott E.
Ungerer, Jacobus
McWhinney, Brett C.
Lipman, Jeffrey
Roberts, Jason A.
Title Therapeutic drug monitoring of beta-lactam antibiotics in burns patients-A one-year prospective study
Journal name Therapeutic Drug Monitoring   Check publisher's open access policy
ISSN 0163-4356
1536-3694
Publication date 2012-04
Sub-type Article (original research)
DOI 10.1097/FTD.0b013e31824981a6
Volume 34
Issue 2
Start page 160
End page 164
Total pages 5
Place of publication Philadelphia, PA, United States
Publisher Lippincott Williams & Wilkins
Collection year 2013
Language eng
Formatted abstract
Background:
Beta-lactams are first-line antibiotics for the management of superficial infections due to burn injury. There is sparse data available on therapeutic drug monitoring (TDM) in patients with burns in a ward setting. This study was conducted to evaluate the utility of a beta-lactam TDM program in a cohort of burn injury patients in a ward environment.

Methods:
Steady-state blood samples were collected immediately before a scheduled dose. The therapeutic concentration targets assessed were (1) free antibiotic concentrations exceeding the minimum inhibitory concentration (MIC; fT > MIC) and (2) free concentrations ≥4× MIC of the known or suspected pathogen (fT > 4× MIC). The duration of therapy was also assessed.

Results:
A total of 50 patients were included for TDM over a 12-month period. The mean (±SD) age was 49 ± 16 years. The mean percent total body surface area burn was 17 ± 13%. The mean serum creatinine concentration was 86 ± 20 μmole/L. Sixty percent of the patients did not achieve fT > MIC, and only 18% achieved the higher target of fT > 4× MIC. Although all the patients achieved a positive clinical outcome, the duration of antibiotic treatment was shorter in patients who achieved fT > MIC compared with those who did not (4.2 ± 1.1 versus 5.3 ± 2.3 days; P = 0.03).

Conclusions:
We found TDM to be a reliable intervention for burn injury patients in a ward environment. This study supports pharmacokinetic data that burns patients may be at risk of subtherapeutic dosing, which may prolong the duration of antibiotic therapy.
Keyword Beta-lactam antibiotics
Pharmacokinetics
Pharmacodynamics
TDM and dosing
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: UQ Centre for Clinical Research Publications
Official 2013 Collection
School of Medicine Publications
 
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Citation counts: TR Web of Science Citation Count  Cited 15 times in Thomson Reuters Web of Science Article | Citations
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Created: Mon, 09 Apr 2012, 11:40:30 EST by System User on behalf of Anaesthesiology and Critical Care - RBWH