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. 2023 Nov 8;11(1):48.
doi: 10.1186/s40560-023-00699-8.

Efficacy of therapeutic drug monitoring-based antibiotic regimen in critically ill patients: a systematic review and meta-analysis of randomized controlled trials

Nozomi Takahashi  1   2 , Yutaka Kondo  3 , Kenji Kubo  4 , Moritoki Egi  5 , Ken-Ichi Kano  6 , Yoshiyasu Ohshima  7 , Taka-Aki Nakada  8
Affiliations

Efficacy of therapeutic drug monitoring-based antibiotic regimen in critically ill patients: a systematic review and meta-analysis of randomized controlled trials

Nozomi Takahashi et al. J Intensive Care. .

Abstract

Background: The efficacy of therapeutic drug monitoring (TDM)-based antimicrobial dosing optimization strategies on pharmacokinetics/pharmacodynamics and specific drug properties for critically ill patients is unclear. Here, we conducted a systematic review and meta-analysis of randomized controlled trials to evaluate the effectiveness of TDM-based regimen in these patients.

Methods: Articles from three databases were systematically retrieved to identify relevant randomized control studies. Version two of the Cochrane tool for assessing risk of bias in randomized trials was used to assess the risk of bias in studies included in the analysis, and quality assessment of evidence was graded using the Grading of Recommendations Assessment, Development, and Evaluation approach. Primary outcome was the 28-day mortality and secondary outcome were in-hospital mortality, clinical cure, length of stay in the intensive care unit (ICU) and target attainment at day 1 and 3.

Results: In total, 5 studies involving 1011 patients were included for meta-analysis of the primary outcome, of which no significant difference was observed between TDM-based regimen and control groups (risk ratio [RR] 0.94, 95% confidence interval [CI]: 0.77-1.14; I2 = 0%). In-hospital mortality (RR 0.96, 95% CI: 0.76-1.20), clinical cure (RR 1.23, 95% CI: 0.91-1.67), length of stay in the ICU (mean difference 0, 95% CI: - 2.18-2.19), and target attainment at day 1 (RR 1.14, 95% CI: 0.88-1.48) and day 3 (RR 1.35, 95% CI: 0.90-2.03) were not significantly different between the two groups, and all evidence for the secondary outcomes had a low or very low level of certainty because the included studies had serious risk of bias, variation of definition for outcomes, and small sample sizes.

Conclusion: TDM-based regimens had no significant efficacy for clinical or pharmacological outcomes. Further studies with other achievable targets and well-defined outcomes are required.

Trial registration: Clinical trial registration; PROSPERO ( https://www.crd.york.ac.uk/prospero/ ), registry number: CRD 42022371959. Registered 24 November 2022.

Keywords: Antibiotics; Pharmacodynamics; Pharmacokinetics; Sepsis; TDM.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flow diagram of the study selection
Fig. 2
Fig. 2
Forest plot of TDM and control group comparing 28-day mortality (A), hospital mortality (B), ICU length of stay (C), clinical cure (D), target attainment in 24 h (E), and target attainment at day 3 (F). CI confidence interval, df degrees of freedom, M-H Mantel–Haenszel test, IV inverse variance, RR risk ratio, TDM therapeutic drug monitoring
Fig. 3
Fig. 3
Summary of risk of bias for primary outcome in the included studies
See this image and copyright information in PMC

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