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Review
. 2023 Apr 1;45(2):200-208.
doi: 10.1097/FTD.0000000000001067. Epub 2023 Jan 2.

Optimization of Antimicrobial Stewardship Programs Using Therapeutic Drug Monitoring and Pharmacokinetics-Pharmacodynamics Protocols: A Cost-Benefit Review

João Paulo Telles  1   2 , Ronaldo Morales Jr  3   4 , Carolina Hikari Yamada  2   5 , Tatiana A Marins  6 , Vanessa D'Amaro Juodinis  4 , Jaques Sztajnbok  7   8 , Moacyr Silva Jr  9 , Bil Randerson Bassetti  10 , James Albiero  11 , Felipe Francisco Tuon  2
Affiliations
Review

Optimization of Antimicrobial Stewardship Programs Using Therapeutic Drug Monitoring and Pharmacokinetics-Pharmacodynamics Protocols: A Cost-Benefit Review

João Paulo Telles et al. Ther Drug Monit. .

Abstract

Purpose: Antimicrobial stewardship programs are important for reducing antimicrobial resistance because they can readjust antibiotic prescriptions to local guidelines, switch intravenous to oral administration, and reduce hospitalization times. Pharmacokinetics-pharmacodynamics (PK-PD) empirically based prescriptions and therapeutic drug monitoring (TDM) programs are essential for antimicrobial stewardship, but there is a need to fit protocols according to cost benefits. The cost benefits can be demonstrated by reducing toxicity and hospital stay, decreasing the amount of drug used per day, and preventing relapses in infection. Our aim was to review the data available on whether PK-PD empirically based prescriptions and TDM could improve the cost benefits of an antimicrobial stewardship program to decrease global hospital expenditures.

Methods: A narrative review based on PubMed search with the relevant studies of vancomycin, aminoglycosides, beta-lactams, and voriconazole.

Results: TDM protocols demonstrated important cost benefit for patients treated with vancomycin, aminoglycosides, and voriconazole mainly due to reduce toxicities and decreasing the hospital length of stay. In addition, PK-PD strategies that used infusion modifications to meropenem, piperacillin-tazobactam, ceftazidime, and cefepime, such as extended or continuous infusion, demonstrated important cost benefits, mainly due to reducing daily drug needs and lengths of hospital stays.

Conclusions: TDM protocols and PK-PD empirically based prescriptions improve the cost-benefits and decrease the global hospital expenditures.

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Conflict of interest statement

The authors declare no conflict of interest.

References

    1. Huebner C, Flessa S, Huebner NO. The economic impact of antimicrobial stewardship programmes in hospitals: a systematic literature review. J Hosp Infect. 2019;102:369–376.
    1. Zequinao T, Gasparetto J, Oliveira DDS, et al. A broad-spectrum beta-lactam-sparing stewardship program in a middle-income country public hospital: antibiotic use and expenditure outcomes and antimicrobial susceptibility profiles. Braz J Infect Dis. 2020;24:221–230.
    1. Ye ZK, Tang HL, Zhai SD. Benefits of therapeutic drug monitoring of vancomycin: a systematic review and meta-analysis. PLoS One. 2013;8:e77169.
    1. Lee BV, Fong G, Bolaris M, et al. Cost-benefit analysis comparing trough, two-level AUC and Bayesian AUC dosing for vancomycin. Clin Microbiol Infect. 2021;27:1346 e1–e7.
    1. Thalhammer F, Traunmüller F, El Menyawi I, et al. Continuous infusion versus intermittent administration of meropenem in critically ill patients. J Antimicrob Chemother. 1999;43:523–527.

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