title: Therapeutic drug monitoring of the β-lactam antibiotics: what is the evidence and which patients should we be using it for?
abstract: Traditional antibiotic dosing was not designed for today's escalating antibiotic resistance, lack of novel antibiotics and growing complexity in patient populations. Dosing that ensures optimal antibiotic exposures should be considered essential to increase the likelihood of effective patient treatment. Given the variability in these exposures across different patients, a 'one-dose-fits-all' approach is increasingly problematic. Therapeutic drug monitoring (TDM) of the β-lactams, the most widely used antibiotic class, is underutilized in certain populations. Clinical experience with β-lactam TDM remains relatively scarce. Patients most likely to benefit from such an intervention include the critically ill, the obese, the elderly and those with cystic fibrosis. Most centres actively performing β-lactam TDM target a minimum 100% of the time during the dosing interval that the free (unbound) concentration of antibiotic exceeds the MIC of the pathogen (100% fT>MIC), which is higher than a traditional target supported by in vitro data. Ideally, isolated pathogens should undergo MIC testing along with TDM on a regular basis, allowing clinicians to address the triad of bug, drug and patient ('mug') in equal measure.
authors.affiliation: Infection Control Programme, Geneva University Hospitals and Faculty of Medicine, Rue Gabrielle-Gentil-Perret 4, 1211 Geneva, Switzerland.
authors.forename: Angela
authors.initials: A
authors.lastname: Huttner
authors.affiliation: Infection Control Programme, Geneva University Hospitals and Faculty of Medicine, Rue Gabrielle-Gentil-Perret 4, 1211 Geneva, Switzerland.
authors.forename: Stephan
authors.initials: S
authors.lastname: Harbarth
authors.affiliation: Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK.
authors.forename: William W
authors.initials: WW
authors.lastname: Hope
authors.affiliation: Burns, Trauma and Critical Care Research Centre, The University of Queensland, Brisbane, Australia Department of Intensive Care, Royal Brisbane and Women's Hospital, Brisbane, Australia.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Lipman
authors.affiliation: Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK Burns, Trauma and Critical Care Research Centre, The University of Queensland, Brisbane, Australia Department of Intensive Care, Royal Brisbane and Women's Hospital, Brisbane, Australia Pharmacy Department, Royal Brisbane and Women's Hospital, Brisbane, Australia j.roberts2@uq.edu.au.
authors.forename: Jason A
authors.initials: JA
authors.lastname: Roberts
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001419:Bacteria / Q000187:drug effects / Q000302:isolation & purification; D001424:Bacterial Infections / Q000188:drug therapy*; D016903:Drug Monitoring / Q000379:methods* / Q000706:statistics & numerical data; D006801:Humans; D008826:Microbial Sensitivity Tests; D047090:beta-Lactams / Q000627:therapeutic use*
chemical_list: D000900:Anti-Bacterial Agents; D047090:beta-Lactams