The therapeutic monitoring of antimicrobial agents

• Published in: British journal of clinical pharmacology Vol. 47; no. 1; pp. 23 - 30
• Main Authors: Begg, Evan J., Barclay, Murray L., Kirkpatrick, Carl J. M.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Science Ltd 01.01.1999; Blackwell Science; Blackwell Science Inc
• Subjects: Aminoglycosides - pharmacology; Aminoglycosides - therapeutic use; Anti-Infective Agents - pharmacology; Anti-Infective Agents - therapeutic use; Antibacterial agents; Antibiotics. Antiinfectious agents. Antiparasitic agents; Antifungal Agents - pharmacology; Antifungal Agents - therapeutic use; antimicrobial agents; Biological and medical sciences; Drug Monitoring - methods; Flucytosine - pharmacology; Flucytosine - therapeutic use; Humans; Itraconazole - pharmacology; Itraconazole - therapeutic use; Medical sciences; Original; Pharmacology. Drug treatments; Teicoplanin - pharmacology; Teicoplanin - therapeutic use; therapeutic drug monitoring; Vancomycin - administration & dosage; Vancomycin - therapeutic use; Human; Therapeutic drug monitoring; Dosage adjustment; Antibiotic; Use; Interindividual comparison; Single daily dose; Review; Antibacterial agent; Pharmacokinetics; Biological activity; Optimization
• ISSN: 0306-5251; 1365-2125
• DOI: 10.1046/j.1365-2125.1999.00850.x

Aims To review the basis and optimal use of therapeutic drug monitoring of antimicrobial agents. Methods Antimicrobial agents for which a reasonable case exists for therapeutic drug monitoring were reviewed under the following headings: pharmacokinetics, why monitor, therapeutic range, individualisation of therapy, sampling times, methods of analysis, interpretative problems and cost‐effectiveness of monitoring. Results There is a strong historical case for monitoring aminoglycosides. The recent move to once‐daily dosing means that criteria for therapeutic drug monitoring need to be redefined. Vancomycin has been monitored routinely but many questions remain about the most appropriate approach to this. A case can be made for monitoring teicoplanin, flucytosine and itraconazole in certain circumstances. Conclusions The approach to monitoring aminoglycosides needs to be redefined in the light of once‐daily dosing. It is premature to suggest that less stringent monitoring is necessary as toxicity remains a problem with these drugs. The ideal method of monitoring vancomycin remains to be defined although a reasonable case exists for measuring trough concentrations, mainly to ensure efficacy. Teicoplanin is monitored occasionally to ensure efficacy while flucytosine is monitored occasionally to avoid high concentrations associated with toxicity. Itraconazole has various pharmacokinetic problems and monitoring has been suggested to ensure that adequate concentrations are achieved.