Therapeutic drug monitoring of antimicrobials

Roberts, Jason A., Norris, Ross, Paterson, David L. and Martin, Jennifer H. (2012) Therapeutic drug monitoring of antimicrobials. British Journal of Clinical Pharmacology, 73 1: 27-36. doi:10.1111/j.1365-2125.2011.04080.x


Author Roberts, Jason A.
Norris, Ross
Paterson, David L.
Martin, Jennifer H.
Title Therapeutic drug monitoring of antimicrobials
Journal name British Journal of Clinical Pharmacology   Check publisher's open access policy
ISSN 0306-5251
1365-2125
Publication date 2012-01-01
Year available 2011
Sub-type Article (original research)
DOI 10.1111/j.1365-2125.2011.04080.x
Open Access Status Not Open Access
Volume 73
Issue 1
Start page 27
End page 36
Total pages 10
Place of publication Oxford, United Kingdom
Publisher Wiley-Blackwell
Language eng
Abstract Optimising prescription of antimicrobials is required to improve clinical outcome from infections and to reduce the development of antimicrobial resistance. One such method to improve antimicrobial dosing in individual patients is through application of therapeutic drug monitoring (TDM). The aim of this manuscript is to review the place of TDM in the dosing of antimicrobial agents, specifically the importance of pharmacokinetics (PK) and pharmacodynamics (PD) to define the antimicrobial exposures necessary for maximizing killing or inhibition of bacterial growth. In this context, there is robust data for some antimicrobials including the ratio of a PK parameter (e.g. peak concentration) to the minimum inhibitory concentration of the bacteria associated with maximal antimicrobial effect. Blood sampling of an individual patient can then further define the relevant PK parameter value in that patient and, if necessary, antimicrobial dosing can be adjusted to enable achievement of the target PK/PD ratio. To date, the clinical outcome benefits of a systematic TDM program for antimicrobials have only been demonstrated for aminoglycosides, although the decreasing susceptibility of bacteria to available antimicrobials, the increasing costs of pharmaceuticals as well as emerging data on pharmacokinetic variability suggests that benefits are likely.
Keyword Antibacterial
Antibiotic
Assay
Pharmacokinetics
Pharmacodynamics
Target concentration intervention
Therapeutic drug management
Q-Index Code C1
Q-Index Status Confirmed Code
Grant ID 519702
569917
Institutional Status UQ
Additional Notes Article first published online: 8 DEC 2011

 
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Created: Wed, 19 Oct 2011, 23:13:35 EST by Laurie Beechey on behalf of UQ Centre for Clinical Research