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Antimicrobial therapeutic drug monitoring in critically ill adult patients : a Position Paper

Abdul-Aziz, Mohd H. ; Alffenaar, Jan Willem C. ; Bassetti, Matteo ; Bracht, Hendrik ; Dimopoulos, George ; Marriott, Deborah ; Neely, Michael N. ; Paiva, Jose Artur ; Pea, Federico and Sjovall, Fredrik LU orcid , et al. (2020) In Intensive Care Medicine 46(6). p.1127-1153
Abstract

Purpose: This Position Paper aims to review and discuss the available data on therapeutic drug monitoring (TDM) of antibacterials, antifungals and antivirals in critically ill adult patients in the intensive care unit (ICU). This Position Paper also provides a practical guide on how TDM can be applied in routine clinical practice to improve therapeutic outcomes in critically ill adult patients. Methods: Literature review and analysis were performed by Panel Members nominated by the endorsing organisations, European Society of Intensive Care Medicine (ESICM), Pharmacokinetic/Pharmacodynamic and Critically Ill Patient Study Groups of European Society of Clinical Microbiology and Infectious Diseases (ESCMID), International Association for... (More)

Purpose: This Position Paper aims to review and discuss the available data on therapeutic drug monitoring (TDM) of antibacterials, antifungals and antivirals in critically ill adult patients in the intensive care unit (ICU). This Position Paper also provides a practical guide on how TDM can be applied in routine clinical practice to improve therapeutic outcomes in critically ill adult patients. Methods: Literature review and analysis were performed by Panel Members nominated by the endorsing organisations, European Society of Intensive Care Medicine (ESICM), Pharmacokinetic/Pharmacodynamic and Critically Ill Patient Study Groups of European Society of Clinical Microbiology and Infectious Diseases (ESCMID), International Association for Therapeutic Drug Monitoring and Clinical Toxicology (IATDMCT) and International Society of Antimicrobial Chemotherapy (ISAC). Panel members made recommendations for whether TDM should be applied clinically for different antimicrobials/classes. Results: TDM-guided dosing has been shown to be clinically beneficial for aminoglycosides, voriconazole and ribavirin. For most common antibiotics and antifungals in the ICU, a clear therapeutic range has been established, and for these agents, routine TDM in critically ill patients appears meritorious. For the antivirals, research is needed to identify therapeutic targets and determine whether antiviral TDM is indeed meritorious in this patient population. The Panel Members recommend routine TDM to be performed for aminoglycosides, beta-lactam antibiotics, linezolid, teicoplanin, vancomycin and voriconazole in critically ill patients. Conclusion: Although TDM should be the standard of care for most antimicrobials in every ICU, important barriers need to be addressed before routine TDM can be widely employed worldwide.

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type
Contribution to journal
publication status
published
subject
keywords
Antibacterials, Antifungals, Antivirals, Pharmacodynamics, Pharmacokinetics, Sepsis
in
Intensive Care Medicine
volume
46
issue
6
pages
1127 - 1153
publisher
Springer
external identifiers
  • scopus:85084310195
  • pmid:32383061
ISSN
0342-4642
DOI
10.1007/s00134-020-06050-1
language
English
LU publication?
no
id
0c83fab8-8f58-4eab-a338-aca48b3a7b38
date added to LUP
2020-05-26 10:24:37
date last changed
2024-04-17 09:38:11
@article{0c83fab8-8f58-4eab-a338-aca48b3a7b38,
  abstract     = {{<p>Purpose: This Position Paper aims to review and discuss the available data on therapeutic drug monitoring (TDM) of antibacterials, antifungals and antivirals in critically ill adult patients in the intensive care unit (ICU). This Position Paper also provides a practical guide on how TDM can be applied in routine clinical practice to improve therapeutic outcomes in critically ill adult patients. Methods: Literature review and analysis were performed by Panel Members nominated by the endorsing organisations, European Society of Intensive Care Medicine (ESICM), Pharmacokinetic/Pharmacodynamic and Critically Ill Patient Study Groups of European Society of Clinical Microbiology and Infectious Diseases (ESCMID), International Association for Therapeutic Drug Monitoring and Clinical Toxicology (IATDMCT) and International Society of Antimicrobial Chemotherapy (ISAC). Panel members made recommendations for whether TDM should be applied clinically for different antimicrobials/classes. Results: TDM-guided dosing has been shown to be clinically beneficial for aminoglycosides, voriconazole and ribavirin. For most common antibiotics and antifungals in the ICU, a clear therapeutic range has been established, and for these agents, routine TDM in critically ill patients appears meritorious. For the antivirals, research is needed to identify therapeutic targets and determine whether antiviral TDM is indeed meritorious in this patient population. The Panel Members recommend routine TDM to be performed for aminoglycosides, beta-lactam antibiotics, linezolid, teicoplanin, vancomycin and voriconazole in critically ill patients. Conclusion: Although TDM should be the standard of care for most antimicrobials in every ICU, important barriers need to be addressed before routine TDM can be widely employed worldwide.</p>}},
  author       = {{Abdul-Aziz, Mohd H. and Alffenaar, Jan Willem C. and Bassetti, Matteo and Bracht, Hendrik and Dimopoulos, George and Marriott, Deborah and Neely, Michael N. and Paiva, Jose Artur and Pea, Federico and Sjovall, Fredrik and Timsit, Jean F. and Udy, Andrew A. and Wicha, Sebastian G. and Zeitlinger, Markus and De Waele, Jan J. and Roberts, Jason A.}},
  issn         = {{0342-4642}},
  keywords     = {{Antibacterials; Antifungals; Antivirals; Pharmacodynamics; Pharmacokinetics; Sepsis}},
  language     = {{eng}},
  month        = {{05}},
  number       = {{6}},
  pages        = {{1127--1153}},
  publisher    = {{Springer}},
  series       = {{Intensive Care Medicine}},
  title        = {{Antimicrobial therapeutic drug monitoring in critically ill adult patients : a Position Paper}},
  url          = {{http://dx.doi.org/10.1007/s00134-020-06050-1}},
  doi          = {{10.1007/s00134-020-06050-1}},
  volume       = {{46}},
  year         = {{2020}},
}