Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2022 Feb 1;44(1):103-111.
doi: 10.1097/FTD.0000000000000949.

Antibiotic Stewardship and Therapeutic Drug Monitoring of β-Lactam Antibiotics: Is There a Link? An Opinion Paper

Daniel C Richter  1 , Alexandra Heininger  2 , Ute Chiriac  3 , Otto Roman Frey  4 , Heike Rau  4 , Thomas Fuchs  5 , Anka C Röhr  4 , Alexander Brinkmann  5 , Markus A Weigand  1
Affiliations
Review

Antibiotic Stewardship and Therapeutic Drug Monitoring of β-Lactam Antibiotics: Is There a Link? An Opinion Paper

Daniel C Richter et al. Ther Drug Monit. .

Abstract

Purpose: In critically ill patients, changes in the pharmacokinetics (PK) of β-lactams can lead to significant variations in serum concentrations, with possibly detrimental effects on outcomes. The utilization of individually calculated doses, extended infusion regimen, and therapeutic drug monitoring (TDM)-guided dose adjustments can mitigate the PK changes and help to achieve and attain an individual PK target.

Methods: We reviewed relevant literature from 2004 to 2021 using 4 search engines (PubMed, Web of Science, Scopus, and Google Scholar). Unpublished clinical data were also examined.

Results: TDM-guided, individualized dosing strategies facilitated PK target attainment and improved patient outcomes. TDM-guided therapy is a core concept of individualized dosing that increases PK target attainment and identifies possible toxic β-lactam concentrations.

Conclusions: Individualized dosing and TDM facilitate the rational use of β-lactams and are integral for antibiotic stewardship interventions in critical care, affording the optimal exposure of both pathogen and drugs, along with enhanced treatment efficacy and reduced emergence of antimicrobial resistance.

PubMed Disclaimer

Conflict of interest statement

D. C. Richter has received refunding of travel expenses from Gilead, Astellas Pharma, and Pfizer. M. A. Weigand has received lecture fees and/or travel expenses from Astellas Pharma, Astra Zeneca, B. Braun, Biosyn, CLS Behring, Cytosorb, Eli Lilly, GE Healthcare, Gilead, Glaxo Smith Kline, Janssen, Köhler Chemie, MSD Sharp & Dohme, Novartis, Orion & Pfizer Pharma, and is a member of advisory boards for Astellas Pharma, B. Braun, Gilead, MSD Sharp & Dohme, Pall Medical & Pfizer Pharma. A. Brinkmann has received lecture fees and/or travel expenses from Pfizer Pharma GmbH, Fresenius Medical Care (FMC), Laboratory Volkmann, Karlsruhe, and Labor Limbach. The other authors declare no conflict of interest.

References

    1. Ferrer R, Martin-Loeches I, Phillips G, et al. Empiric antibiotic treatment reduces mortality in severe sepsis and septic shock from the first hour: results from a guideline-based performance improvement program. Crit Care Med. 2014;42:1749–1755.
    1. Kumar A, Ellis P, Arabi Y, et al.; Cooperative Antimicrobial Therapy of Septic Shock Database Research Group. Initiation of inappropriate antimicrobial therapy results in a fivefold reduction of survival in human septic shock. Chest. 2009;136:1237–1248.
    1. Fleischmann C, Scherag A, Adhikari NK, et al. Assessment of global incidence and mortality of hospital-treated sepsis. Current estimates and limitations. Am J Respir Crit Care Med. 2016;193:259–272.
    1. Paiva JA, Pereira JM, Tabah A, et al. Characteristics and risk factors for 28-day mortality of hospital acquired fungemias in ICUs: data from the EUROBACT study. Crit Care. 2016;20:53.
    1. WHO 2019. New Report Calls for Urgent Action to Avert Antimicrobial Resistance Crisis. Available at: https://www.who.int/news/item/29-04-2019-new-report-calls-for-urgent-act... . Accessed November 4, 2021.

LinkOut - more resources