title: Therapeutic drug monitoring of beta-lactam antibiotics in burns patients--a one-year prospective study.
abstract: BACKGROUND
  Beta-lactams are first-line antibiotics for the management of superficial infections due to burn injury. There is sparse data available on therapeutic drug monitoring (TDM) in patients with burns in a ward setting. This study was conducted to evaluate the utility of a beta-lactam TDM program in a cohort of burn injury patients in a ward environment.
  
  
  METHODS
  Steady-state blood samples were collected immediately before a scheduled dose. The therapeutic concentration targets assessed were (1) free antibiotic concentrations exceeding the minimum inhibitory concentration (MIC; fT > MIC) and (2) free concentrations ≥4× MIC of the known or suspected pathogen (fT > 4× MIC). The duration of therapy was also assessed.
  
  
  RESULTS
  A total of 50 patients were included for TDM over a 12-month period. The mean (±SD) age was 49 ± 16 years. The mean percent total body surface area burn was 17 ± 13%. The mean serum creatinine concentration was 86 ± 20 μmole/L. Sixty percent of the patients did not achieve fT > MIC, and only 18% achieved the higher target of fT > 4× MIC. Although all the patients achieved a positive clinical outcome, the duration of antibiotic treatment was shorter in patients who achieved fT > MIC compared with those who did not (4.2 ± 1.1 versus 5.3 ± 2.3 days; P = 0.03).
  
  
  CONCLUSIONS
  We found TDM to be a reliable intervention for burn injury patients in a ward environment. This study supports pharmacokinetic data that burns patients may be at risk of subtherapeutic dosing, which may prolong the duration of antibiotic therapy.
authors.affiliation: Burns, Trauma, and Critical Care Research Centre, The University of Queensland, Brisbane, Australia. drbhavikpatel@hotmail.com
authors.forename: Bhavik M
authors.initials: BM
authors.lastname: Patel
authors.forename: Jennifer
authors.initials: J
authors.lastname: Paratz
authors.forename: Natalie C
authors.initials: NC
authors.lastname: See
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Muller
authors.forename: Michael
authors.initials: M
authors.lastname: Rudd
authors.forename: David
authors.initials: D
authors.lastname: Paterson
authors.forename: Scott E
authors.initials: SE
authors.lastname: Briscoe
authors.forename: Jacobus
authors.initials: J
authors.lastname: Ungerer
authors.forename: Brett C
authors.initials: BC
authors.lastname: McWhinney
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Lipman
authors.forename: Jason A
authors.initials: JA
authors.lastname: Roberts
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000493:pharmacokinetics* / Q000627:therapeutic use; D001424:Bacterial Infections / Q000188:drug therapy* / Q000209:etiology / Q000382:microbiology; D001830:Body Surface Area; D002056:Burns / Q000150:complications*; D003404:Creatinine / Q000097:blood; D016903:Drug Monitoring / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D011446:Prospective Studies; D013997:Time Factors; D047090:beta-Lactams / Q000008:administration & dosage / Q000493:pharmacokinetics* / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D047090:beta-Lactams; D003404:Creatinine