β-Lactam therapeutic drug monitoring in the critically ill: optimising drug exposure in patients with fluctuating renal function and hypoalbuminaemia

Hayashi, Yoshiro, Lipman, Jeffrey, Udy, Andrew A., Ng, Mandy, McWhinney, Brett, Ungerer, Jacobus, Lust, Karin and Roberts, Jason A. (2013) β-Lactam therapeutic drug monitoring in the critically ill: optimising drug exposure in patients with fluctuating renal function and hypoalbuminaemia. International Journal of Antimicrobial Agents, 41 2: 162-166. doi:10.1016/j.ijantimicag.2012.10.002


Author Hayashi, Yoshiro
Lipman, Jeffrey
Udy, Andrew A.
Ng, Mandy
McWhinney, Brett
Ungerer, Jacobus
Lust, Karin
Roberts, Jason A.
Title β-Lactam therapeutic drug monitoring in the critically ill: optimising drug exposure in patients with fluctuating renal function and hypoalbuminaemia
Formatted title
Beta-lactam therapeutic drug monitoring in the critically ill: optimising drug exposure in patients with fluctuating renal function and hypoalbuminaemia
Journal name International Journal of Antimicrobial Agents   Check publisher's open access policy
ISSN 0924-8579
1872-7913
Publication date 2013-02-01
Year available 2012
Sub-type Article (original research)
DOI 10.1016/j.ijantimicag.2012.10.002
Open Access Status Not yet assessed
Volume 41
Issue 2
Start page 162
End page 166
Total pages 5
Place of publication Amsterdam, Netherlands
Publisher Elsevier
Language eng
Subject 2726 Microbiology (medical)
2725 Infectious Diseases
2736 Pharmacology (medical)
Abstract β-Lactams are routinely prescribed in the treatment of serious infections. Empirical dosing schedules are typically derived from studies in healthy volunteers and largely fail to consider the significant changes in antibacterial pharmacokinetics often encountered in the critically ill. These changes are primarily driven by the underlying pathophysiology and the interventions provided, leading to altered protein binding, poor tissue penetration, and fluctuations in the volume of distribution and drug clearance. Each separately, and in combination, is likely to complicate successful β-lactam administration in this setting. Although antibacterial therapeutic drug monitoring (TDM) has traditionally been employed to minimise drug toxicity, the challenges to achieving ‘optimal’ drug concentrations in the critically ill suggest β-lactam TDM as an attractive means to optimise drug exposure. Whilst there is currently little evidence to support routine widespread application of such a service, β-lactam TDM may still have a role in select patients where difficulty in establishing therapeutic concentrations can be illustrated. This series utilises three representative cases from a β-lactam TDM service that highlight the utility of this intervention in optimising antibacterial dosing. These preliminary data support an expanding role for β-lactam TDM in select critically ill patients and provide insight into the subpopulations most at risk of suboptimal drug exposure. Future studies investigating the clinical outcome benefits of β-lactam TDM in these patient groups are now warranted.
Keyword β-Lactams
Therapeutic drug monitoring
Intensive care
Pharmacokinetics
Q-Index Code C1
Q-Index Status Confirmed Code
Grant ID 569917
Institutional Status UQ
Additional Notes © 2012

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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Created: Mon, 26 Nov 2012, 01:31:47 EST by Matthew Lamb on behalf of School of Medicine