Diagnostic and medical needs for therapeutic drug monitoring of antibiotics

• Published in: European journal of clinical microbiology & infectious diseases Vol. 39; no. 5; pp. 791 - 797
• Main Authors: Mabilat, Claude, Gros, Marie Francoise, Nicolau, David, Mouton, Johan W., Textoris, Julien, Roberts, Jason A., Cotta, Menino O., van Belkum, Alex, Caniaux, Isabelle
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.05.2020; Springer Nature B.V
• Subjects: Aging; Aminoglycosides; Anti-Bacterial Agents - pharmacokinetics; Anti-Bacterial Agents - therapeutic use; Antibiotics; Bacteria - drug effects; Biomedical and Life Sciences; Biomedicine; Clinical Trials as Topic; Critical Care; Diagnostic systems; Drug dosages; Drug Monitoring; Drug Resistance, Multiple, Bacterial; Humans; Immunosuppression; Intensive Care Units; Internal Medicine; Medical Microbiology; Microbial Sensitivity Tests; Minimum inhibitory concentration; Monitoring; Patients; Review; Technology assessment; Telemedicine; Therapeutic drug monitoring; Toxicity; Vancomycin; β-Lactam antibiotics
• ISSN: 0934-9723; 1435-4373
• DOI: 10.1007/s10096-019-03769-8

Therapeutic drug monitoring (TDM) of antibiotics has been practiced for more than half a century, but it is still not widely applied for infected patients. It has a traditional focus on limiting toxicity of specific classes of antibiotics such as aminoglycosides and vancomycin. With more patients in critical care with higher levels of sickness severity and immunosuppression as well as an increasingly obese and ageing population, an increasing risk of suboptimal antibiotic exposure continues to escalate. As such, the value of TDM continues to expand, especially for beta-lactams which constitute the most frequently used antibiotic class. To date, the minimum inhibitory concentration (MIC) of infectious microbes rather than classification in terms of susceptible and resistant can be reported. In parallel, increasingly sophisticated TDM technology is becoming available ensuring that TDM is feasible and can deliver personalized antibiotic dosing schemes. There is an obvious need for extensive studies that will quantify the improvements in clinical outcome of individual TDM-guided dosing. We suggest that a broad diagnostic and medical investigation of the TDM arena, including market analyses and analytical technology assessment, is a current priority.