Therapeutic Drug Monitoring of Antibiotics: Defining the Therapeutic Range

Abstract

In the present narrative review, the authors aimed to discuss the relationship between the pharmacokinetic/ pharmacodynamic (PK/PD) of antibiotics and clinical response (including efficacy and toxicity). In addition, this review describes how this relationship can be applied to define the therapeutic range of a particular antibiotic (or antibiotic class) for therapeutic drug monitoring (TDM).Methods: Relevant clinical studies that examined the relationship between PK/PD of antibiotics and clinical response (efficacy and response) were reviewed. The review (performed for studies published in English up to September 2021) assessed only commonly used antibiotics (or antibiotic classes), including aminoglycosides, beta-lactam antibiotics, daptomycin, fluoroquinolones, glycopeptides (teicoplanin and vancomycin), and linezolid. The best currently available evidence was used to define the therapeutic range for these antibiotics. Results:The therapeutic range associated with maximal clinical efficacy and minimal toxicity is available for commonly used antibiotics, and these values can be implemented when TDM for antibiotics is performed. Additional data are needed to clarify the relationship between PK/PD indices and the development of antibiotic resistance.Conclusions: TDM should only be regarded as a means to achieve the main goal of providing safe and effective antibiotic therapy for all patients. The next critical step is to define exposures that can prevent the development of antibiotic resistance and include these exposures as therapeutic drug monitoring targets.

Pharmacodynamics of Flucloxacillin in a Neutropenic Murine Thigh Infection Model: A Piece of the Puzzle towards Evidence-Based Dosing

“…For two broad spectrum carbapenems, including efficacy against methicillin-resistant Staphylococcus aureus (MRSA), the magnitude found for stasis was only 5 ± 1.4% f T > MIC for razupenem and 27% for tomopenem [ 19 , 20 ]. The PK/PD targets for Gram-negative bacteria is generally much higher (40–70% f T > MIC) [ 21 , 22 ].…”

Machines that help machines to help patients: optimising antimicrobial dosing in patients receiving extracorporeal membrane oxygenation and renal replacement therapy using dosing software

“…17 Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia. 18 Faculty of Health Sciences and Medicine, Bond University, Gold Coast, QLD, Australia. 19 School of Pharmacy, University of Waterloo, 10 Victoria St S. Kitchener, Waterloo, ON N2G 1C5, Canada.…”

“…However, each antimicrobial/antimicrobial class exhibits different pharmacokinetic/pharmacodynamic (PK/PD) indices that are associated with increased effectiveness [ 17 ], and achieving these concentration exposures increases the likelihood of therapeutic of response. Clear relationships have been described for most antimicrobials linking plasma PK/PD exposures with clinical efficacy [ 8 , 18 ] and for some drugs, toxicity [ 8 , 18 ]. Therefore, antimicrobial dosing that can achieve and maintain plasma antimicrobial concentrations within this therapeutic exposure range increases the likelihood of therapeutic clinical efficacy whilst limiting the probability of toxicity in patients receiving ECMO and/or RRT.…”

Successful Integration of Clinical Pharmacists in an OPAT Program: A Real-Life Multidisciplinary Circuit

“…It would be useful to monitor the levels of other antibiotic families, but it is known that resources and funding are limited in many institutions. In these cases, publicly available data define the therapeutic ranges of antimicrobials, a valid tool for treatment optimization and ADR minimization [ 90 ]. In our HaH unit, we maintain TDM on further patient treatments beyond antimicrobials, such as immunosuppressive or antiepileptic drugs.…”