Update on Therapeutic Drug Monitoring of Beta-Lactam Antibiotics in Critically Ill Patients—A Narrative Review

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Authors

STAŠEK Jan KELLER Filip KOČÍ Veronika KLUČKA Jozef KLABUSAYOVÁ Eva WIEWIORKA Ondřej STRAŠILOVÁ Zuzana BEŇOVSKÁ Miroslava ŠKARDOVÁ Markéta MALÁSKA Jan

Year of publication 2023
Type Article in Periodical
Magazine / Source Antibiotics
MU Faculty or unit

Faculty of Medicine

Citation
Web https://www.mdpi.com/2079-6382/12/3/568
Doi http://dx.doi.org/10.3390/antibiotics12030568
Keywords beta-lactam antibiotics; pharmacokinetics–pharmacodynamics; critically ill; bacterial susceptibility; therapeutic drug monitoring; high-performance liquid chromatography
Attached files
Description Beta-lactam antibiotics remain one of the most preferred groups of antibiotics in critical care due to their excellent safety profiles and their activity against a wide spectrum of pathogens. The cornerstone of appropriate therapy with beta-lactams is to achieve an adequate plasmatic concentration of a given antibiotic, which is derived primarily from the minimum inhibitory concentration (MIC) of the specific pathogen. In a critically ill patient, the plasmatic levels of drugs could be affected by many significant changes in the patient’s physiology, such as hypoalbuminemia, endothelial dysfunction with the leakage of intravascular fluid into interstitial space and acute kidney injury. Predicting antibiotic concentration from models based on non-critically ill populations may be misleading. Therapeutic drug monitoring (TDM) has been shown to be effective in achieving adequate concentrations of many drugs, including beta-lactam antibiotics. Reliable methods, such as high-performance liquid chromatography, provide the accurate testing of a wide range of beta-lactam antibiotics. Long turnaround times remain the main drawback limiting their widespread use, although progress has been made recently in the implementation of different novel methods of antibiotic testing. However, whether the TDM approach can effectively improve clinically relevant patient outcomes must be proved in future clinical trials.
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