Therapeutic drug monitoring of antibiotics in intensive care unit: for whom and how?

Abstract

Numerous studies show the impact of therapeutic antibiotic monitoring (TDM) on the reduction of therapeutic failure and toxicity in intensive care patients. Its value is notably related to (i) the severity and site of infection, (ii) the bacteria isolated and its resistance profile, (iii) the pharmacodynamic (PD) profile of the ATB used and its level of toxicity, and (iv) the pharmacokinetic (PK) profile of the patient. The objective of this update is to describe the clinical and microbiological situations for which the TDM has been shown to be useful and to indicate, by therapeutic class, the PK/PD elements necessary for a proper interpretation of the results. Clinically, TDM is particularly relevant in cases of severe infections and/or in patients with variations of volume of distribution or clearance. ATB concentrations should ideally be compared to the minimal inhibitory concentration of the isolated organism. However, additional clinical data are needed to clarify the patient, infection, and bacterial profile for which TDM would make the greatest contribution.