ABSTRACT

Introduction

Individualizing antibiotic therapy is paramount to improve clinical outcomes while minimizing the risk of toxicity and antimicrobial therapy. β-lactam antibiotics are amongst the drugs most commonly prescribed in the Intensive Care Unit (ICU). The pharmacokinetics of β-lactam antibiotics are profoundly altered in critically ill patients, leading to the failure of standard drug dosing regimens to result in adequate drug concentrations. Therapeutic Drug Monitoring (TDM) of β-lactam antibiotics is a promising tool to help optimize β-lactam antibiotic therapy.

Areas covered

The rationale behind TDM for β-lactam antibiotics is explained, as well as some more practical aspects such as when to sample, what concentrations to strive for and how to use it in clinical practice. We also discuss microbiological and analytical considerations, knowledge gaps, and future perspectives of β-lactam antibiotics TDM in ICU patients.

Expert opinion

TDM of β-lactam antibiotics has been studied intensively in recent years. While TDM may not yet be widely available, and targets need to be further refined, TDM of β-lactam antibiotics will help to optimize antibiotic therapy in the critically ill patient, as an integrated part of an antimicrobial stewardship program.

中文翻译：

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重症监护病房中β-内酰胺抗生素的治疗药物监测。

摘要

介绍

个体化抗生素治疗对于改善临床结果同时最小化毒性和抗微生物治疗的风险至关重要。β-内酰胺类抗生素是加护病房（ICU）最常用的药物之一。β-内酰胺类抗生素的药代动力学在重症患者中发生了深刻变化，导致标准药物给药方案无法产生足够的药物浓度。β-内酰胺类抗生素的治疗药物监测（TDM）是有助于优化β-内酰胺类抗生素治疗的有前途的工具。

覆盖区域

解释了TDM用于β-内酰胺类抗生素的基本原理，以及一些更实际的方面，例如何时取样，要争取的浓度以及如何在临床实践中使用它。我们还将讨论ICU患者中β-内酰胺类抗生素TDM的微生物学和分析性考量，知识差距以及未来前景。

专家意见

近年来，对β-内酰胺类抗生素的TDM进行了深入研究。尽管TDM可能尚未广泛使用，并且目标需要进一步完善，但作为抗菌素管理计划的组成部分，β-内酰胺抗生素的TDM将有助于优化重症患者的抗生素治疗。