Does beta-lactam pharmacokinetic variability in critically ill patients justify therapeutic drug monitoring? A systematic review

Sime, Fekade Bruck, Roberts, Michael S., Peake, Sandra L., Lipman, Jeffrey and Roberts, Jason A. (2012) Does beta-lactam pharmacokinetic variability in critically ill patients justify therapeutic drug monitoring? A systematic review. Annals of Intensive Care, 2 1: 35.1-35.11. doi:10.1186/2110-5820-2-35

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Author Sime, Fekade Bruck
Roberts, Michael S.
Peake, Sandra L.
Lipman, Jeffrey
Roberts, Jason A.
Title Does beta-lactam pharmacokinetic variability in critically ill patients justify therapeutic drug monitoring? A systematic review
Journal name Annals of Intensive Care   Check publisher's open access policy
ISSN 2110-5820
Publication date 2012-07-28
Sub-type Critical review of research, literature review, critical commentary
DOI 10.1186/2110-5820-2-35
Open Access Status DOI
Volume 2
Issue 1
Start page 35.1
End page 35.11
Total pages 11
Place of publication Heidelberg, Germany
Publisher SpringerOpen
Collection year 2013
Language eng
Abstract The pharmacokinetics of beta-lactam antibiotics in intensive care patients may be profoundly altered due to the dynamic, unpredictable pathophysiological changes that occur in critical illness. For many drugs, significant increases in the volume of distribution and/or variability in drug clearance are common. When "standard" beta-lactam doses are used, such pharmacokinetic changes can result in subtherapeutic plasma concentrations, treatment failure, and the development of antibiotic resistance. Emerging data support the use of betalactam therapeutic drug monitoring (TDM) and individualized dosing to ensure the achievement of pharmacodynamic targets associated with rapid bacterial killing and optimal clinical outcomes. The purpose of this work was to describe the pharmacokinetic variability of beta-lactams in the critically ill and to discuss the potential utility of TDM to optimize antibiotic therapy through a structured literature review of all relevant publications between 1946 and October 2011. Only a few studies have reported the utility of TDM as a tool to improve beta-lactam dosing in critically ill patients. Moreover, there is little agreement between studies on the pharmacodynamic targets required to optimize antibiotic therapy. The impact of TDM on important clinical outcomes also remains to be established. Whereas TDM may be theoretically rational, clinical studies to assess utility in the clinical setting are urgently required.
Keyword Antibiotics
Beta-lactam
Critically ill
Pharmacodynamics
Pharmacokinetics
Therapeutic drug monitoring
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ
Additional Notes Article number 35

Document type: Journal Article
Sub-type: Critical review of research, literature review, critical commentary
Collections: Official 2013 Collection
School of Medicine Publications
 
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Citation counts: TR Web of Science Citation Count  Cited 38 times in Thomson Reuters Web of Science Article | Citations
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Created: Mon, 17 Dec 2012, 17:21:37 EST by Sia Athanasas on behalf of Anaesthesiology and Critical Care - RBWH