Čes. slov. farm. 2020, 69(1):17-23 | DOI: 10.36290/csf.2020.002

Pharmacokinetic aspects of beta-lactam antibiotic therapy in intensive care unit patients: A one-center experience with TDM

Kateřina Sadilová¹, Milada Halačová^2,*, Dalibor Černý³

¹ Na Homolce Hospital, Department of Clinical Pharmacy, Prague, Czech Republic

² Institute of Pharmacology, 2nd Medical Faculty, Charles University, Prague, Czech Republic

³ Institute of Pharmacology, 1st Medical Faculty, Charles University, Prague, Czech Republic

Early and appropriate antibiotic therapy remains the key intervention for successful treatment of infection in critically ill patients, particularly in the current era of increasing antibiotic resistance. Optimization of the antimicrobial dosing regimens to achieve therapeutic plasma concentrations and concentrations at the site of infection is crucial for maximizing the therapeutic response and minimizing the risk of organ toxicity and is also an important tool to avoid the resistance emergence. Beta-lactam antibiotics have been considered relatively safe and, as opposed to aminoglycosides, therapeutic drug monitoring as a tool conventionally used primarily to minimize toxicity in drugs with narrow therapeutic window or complex pharmacokinetics, has not been provided routinely yet. However, emerging data suggest that optimal antibiotic exposure may not be achieved with traditional dosing strategies in a significant number of critically ill patients and, on the contrary, concerns about insufficient plasma concentrations leading to microbiological and clinical failure are warranted. The treatment of infections in the intensive care unit (ICU) patients is often challenging because of disease complexity, pathophysiologic alterations they undergo and reduced susceptibility of nosocomial pathogens. Therefore, it is of paramount importance to update current recommendations on dosing of beta-lactam antibiotics in severe infections and therapeutic drug monitoring may be regarded as the only exact method to ensure pharmacodynamics target achievement. Na Homolce Hospital is one of the first medical institutions in the Czech Republic where the practice of routine TDM of beta-lactam antibiotics in ICU-patients has been established. In this paper, we introduce our experience and first case reports.

Keywords: pharmacokinetics; beta-lactam antibiotics; dose optimization; pathophysiologic changes; intensive care unit (ICU); therapeutic drug monitoring (TDM)

Grants and funding:

Supported by Ministry of Health, Czech Republic - conceptual development of research organization (NHH, 00023884) IG 168601, IG 168602.

Received: December 16, 2019; Accepted: January 16, 2020; Published: January 1, 2020  Show citation