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Expert Rev Clin Pharmacol. 2016 Jul;9(7):961-79. doi: 10.1586/17512433.2016.1172209. Epub 2016 Apr 15.

Therapeutic drug monitoring of anti-infective agents in critically ill patients.

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a Department of Pharmacy , Academic Medical Center , Amsterdam , The Netherlands.
b Burns Trauma and Critical Care Research Centre , The University of Queensland , Brisbane , Australia.
c Departments of Pharmacy and Intensive Care , Royal Brisbane and Women's Hospital , Brisbane , Australia.
d Department of Intensive Care, Hopital Erasme , Université Libre de Bruxelles (ULB) , Brussels , Belgium.
e School of Pharmacy , The University of Queensland , Brisbane , Australia.


Initial adequate anti-infective therapy is associated with significantly improved clinical outcomes for patients with severe infections. However, in critically ill patients, several pathophysiological and/or iatrogenic factors may affect the pharmacokinetics of anti-infective agents leading to suboptimal drug exposure, in particular during the early phase of therapy. Therapeutic drug monitoring (TDM) may assist to overcome this problem. We discuss the available evidence on the use of TDM in critically ill patient populations for a number of anti-infective agents, including aminoglycosides, β-lactams, glycopeptides, antifungals and antivirals. Also, we present the available evidence on the practices of anti-infective TDM and describe the potential utility of TDM to improve treatment outcome in critically ill patients with severe infections. For aminoglycosides, glycopeptides and voriconazole, beneficial effects of TDM have been established on both drug effectiveness and potential side effects. However, for other drugs, therapeutic ranges need to be further defined to optimize treatment prescription in this setting.


Anti-infectives; antibiotics; antifungals; antivirals; critically ill; intensive care; pharmacokinetic; therapeutic drug monitoring

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