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Therapeutic Drug Monitoring of Beta-Lactams and Other Antibiotics in the Intensive Care Unit: Which Agents, Which Patients and Which Infections?

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Abstract

Antibiotics are among the medications most frequently administered to the critically ill, a population with high levels of intra- and inter-individual pharmacokinetic variability. Our knowledge of the relationships among antibiotic dosing, exposure and clinical effect in this population has increased in recent decades. Therapeutic drug monitoring (TDM) of serum antibiotic concentrations is the most practical means of assessing adequate antibiotic exposure, though until recently, it has been underutilised for this end. Now TDM is becoming more widespread, particularly for the beta-lactam antibiotics, a class historically thought to have a wide therapeutic range. We review the basic requirements, indications, and targets for effective TDM of the glycopeptides, aminoglycosides, quinolones and beta-lactam antibiotics in the adult intensive-care setting, with a special focus on TDM of the beta-lactam antibiotics, the most widely used antibiotic class.

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Acknowledgements

We thank Johan Mouton for his careful review and helpful comments.

Funding

None. A.H. was supported in part by the EU-funded AIDA project (Grant agreement 278348), and B.H. was supported in part by the DRIVE-AB project (Grant agreement 115618), funded in the context of the Innovative Medicines Initiative Joint Undertaking (IMI).

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Authors and Affiliations

  1. Department of Medical Microbiology, Haaglanden Medisch Centrum, The Hague, The Netherlands

    Anouk E. Muller

  2. Department of Medical Microbiology and Infectious Diseases, Erasmus MC, Rotterdam, The Netherlands

    Anouk E. Muller

  3. Division of Infectious Diseases, University Hospitals of Geneva, Rue Gabrielle-Gentil-Perret 4, 1205, Geneva, Switzerland

    Benedikt Huttner & Angela Huttner

Authors
  1. Anouk E. Muller
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  2. Benedikt Huttner
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  3. Angela Huttner
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Corresponding author

Correspondence to Angela Huttner.

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Conflict of Interest

Anouk E. Muller, Benedikt Huttner, Angela Huttner declare no conflicts of interest.

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Muller, A.E., Huttner, B. & Huttner, A. Therapeutic Drug Monitoring of Beta-Lactams and Other Antibiotics in the Intensive Care Unit: Which Agents, Which Patients and Which Infections?. Drugs 78, 439–451 (2018). https://doi.org/10.1007/s40265-018-0880-z

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