#PAGE_PARAMS# #ADS_HEAD_SCRIPTS# #MICRODATA#

TDM of antibio­tics in clinical practice


Authors: I. Kacířová 1,2;  M. Grundmann 1
Authors‘ workplace: Ústav klinické farmakologie, LF OU, Ostrava 1;  Oddělení klinické farmakologie, Ústav laboratorní diagnostiky, FN Ostrava 2
Published in: Kardiol Rev Int Med 2015, 17(1): 57-64
Category: Internal Medicine

Overview

A key strategy in optimizing aminoglycosides and vancomycin therapy is therapeutic drug monitoring. It is a specific method of clinical pharmacology used to monitor the therapy using measurement of drug serum concentrations followed by interpretation by a clinical pharmacologist/ pharmacist and good cooperation with the clinician. Therapeutic drug monitoring helps clinicians to quickly optimize aminoglycosides and vancomycin dosing regimens to maximize the clinical effect, minimize the toxicity of the drugs, decrease mortality and morbidity and reduce costs. Aminoglycosides (amikacin and gentamicin) constitute one of the oldest classes of antimicrobials. Despite their relative toxicity, mainly nephrotoxicity and ototoxicity, aminoglycosides are valuable in current clinical practice. They are bactericidal agents used against aerobic gram‑ negative infections, and in combination with a cell wall active antimicrobial‑based regimen (e. g. b‑ lactams), also against gram‑ positive cocci. Aminoglycosides have a concentration‑ dependent bactericidal effect and a long post‑antibio­tic effect. There is accumulating evidence to show that large, single, daily doses (or more correctly, extended interval dosing) of aminoglycosides are associated with lower nephro‑ and ototoxicity and comparable, if not superior, clinical outcomes than the same total dose administered in small, multiple doses. A general therapeutic range of aminoglycosides does not exist. Every patient has his/ her own optimal target concentration based on the microorganism susceptibility, co‑ administered antibacterials, immune status and co‑ administration of other nephro‑or ototoxic drugs. Minimum serum vancomycin trough concentrations should always be maintained above 10 mg/ L to avoid development of resistance, nevertheless, trough concentrations > 20 mg/ L are not recommended because of the risk of nephrotoxicity. For serious gram‑ positive infections vancomycin trough concentrations of 15– 20 mg/ L are recommended. In non‑complicated infections (urinary tract infections or mild‑ to‑ moderate skin and soft tissue infections) trough concentrations of 10– 15 mg/ L should be sufficient. For continuous infusions of vancomycin target steady‑ state concentration values of 15– 25 mg/ L is optimal. We demonstrate some case reports of therapeutic monitoring of aminoglycoside antibiotics and vancomycine from our routine practice.

Keywords:
therapeutic monitoring –  amikacin –  gentamicin –  vancomycin


Sources

1. Grundmann M, Kacířová I. Význam TDM, fenotypizace a genotypizace pro správné dávkování léčiv. Čas Lék čes 2010; 149: 482– 487.

2. Státní ústav pro kontrolu léčiv. [online] Dostupné z: http:/ / www.sukl.cz/. 

3. Kacířová I, Grundmann M. Terapeutické monitorování amikacinu a gentamicinu v rutinní klinické praxi. Vnitř Lék 2015; 61. [In press].

4. Hanberger H, Edlund C, Furebring M et al. Rational use of aminoglycosides‑ review and recommendations by the Swedish Reference Group for Antibio­tics (SRGA). Scand J Infect Dis 2013; 45: 161– 175. doi: 10.3109/ 00365548.2012.747694.

5. Kacířová I, Grundmann M. Terapeutické monitorování vankomycinu v rutinní klinické praxi. Vnitř Lék 2014; 60: 846– 851.

6. Avent ML, Rogers BA, Cheng AC et al. Current use of aminoglycosides: indications, pharmacokinetics and monitoring for toxicity. Intern Med J 2011; 41: 441– 449. doi: 10.1111/ j.1445– 5994.2011.02452.x.

7. Ye ZK, Tang HL, Zhai SD. Benefits of therapeutic drug monitoring of vancomycin: a systematic review and meta‑analysis. PLoS One 2013; 8: e77169. doi: 10.1371/ journal.pone.0077169.

8. Radigan EA, Gilchrist NA, Miller MA. Management of aminoglycosides in the intensive care unit. J Intensive Care Med 2010; 25: 327– 342. doi: 10.1177/ 0885066610377968.

9. Boyer A, Gruson D, Bouchet S et al. Aminoglycosides in septic shock: an overview, with specific consideration given to their nephrotoxic risk. Drug Saf 2013; 36: 217– 230. doi: 10.1007/ s40264‑ 013‑ 0031‑ 0.

10. Roberts JA, Field J, Visser A et al. Using population pharmacokinetics to determine gentamicin dosing during extended daily diafiltration in critically ill patients with acute kidney injury. Anti­microb Agents Chemother 2010; 54: 3635– 3640. doi: 10.1128/ AAC.00222‑ 10.

11. Habib G, Hoen B, Tornos P et al. Guidelines on the prevention, diagnosis, and treatment of infective endocarditis (new version 2009): the Task Force on the Prevention, Diagnosis, and Treatment of Infective Endocarditis of the European Society of Cardiology (ESC). Endorsed by the European Society of Clinical Microbio­logy and Infectious Dis­eases (ESCMID) and the International Society of Chemotherapy (ISC) for Infection and Cancer. Eur Heart J 2009; 30: 2369– 2413. doi: 10.1093/ eurheartj/ ehp285.

12. Moise‑ Broder PA, Forrest A, Birmingham MC et al. Pharmacodynamics of vancomycin and other antimicrobials in patients with Staphylococcus aureus lower respiratory tract infections. Clin Pharmacokinet 2004; 43: 925– 942.

13. Rybak MJ, Lomaestro BM, Rotschafer JC et al. Vancomycin therapeutic guidelines: a summary of consensus recommendations from the infectious diseases Society of America, the American Society of Health‑ System Pharmacists, and the Society of Infectious Diseases Pharmacists. Clin Infect Dis 2009; 49: 325– 327. doi: 10.1086/ 600877.

14. Matsumoto K, Takesue Y, Ohmagari N et al. Practice guidelines for therapeutic drug monitoring of vancomycin: a consensus review of the Japanese Society of Chemotherapy and the Japanese Society of Therapeutic Drug Monitoring. J Infect Chemother 2013; 19: 365– 380. doi: 10.1007/ s10156‑ 013‑ 0599‑ 4.

15. Martin JH, Norris R, Barras M et al. Therapeutic monitoring of vancomycin in adult patients: a consensus review of the American Society of Health‑ System Pharmacists, the Infectious Dis­eases Society of America, and the Society Of Infectious Diseases Pharmacists. Clin Biochem Rev 2010; 31: 21– 24.

16. Liu C, Bayer A, Cosgrove SE et al. Clinical practice guidelines by the Infectious Diseases Society of America for the treatment of methicillin‑resistant Staphylococcus aureus infections in adults and chil­d­­-ren: Executive summary. Clin Infect Dis 2011; 52: 285– 292. doi: 10.1093/ cid/ cir034.

17. Begg EJ, Barclay ML, Kirkpatrick CM. The therapeutic monitoring of antimicrobial agents. Br J Clin Pharmacol 2001; 52 (Suppl 1): 35S– 43S.

18. Helgason KO, Thomson AH, Ferguson C. A review of vancomycin therapeutic drug monitoring recommendations in Scotland. J Antimicrob Chemother 2008; 61: 1398– 1399. doi: 10.1093/ jac/ dkn114.

19. Nunn MO, Corallo CE, Aubron C et al. Vancomycin dosing: assessment of time to therapeutic concentration and predictive accuracy of pharmacokinetic modeling software. Ann Pharmacother 2011; 45: 757– 763. doi: 10.1345/ aph.1P634.

20. Li J, Udy AA, Kirkpatrick CM et al. Improving vancomycin prescription in critical illness through a drug use evaluation process: a weight‑based dosing intervention study. Int J Antimicrob Agents 2012; 39: 69– 72. doi: 10.1016/ j.ijantimicag.2011.08.017.

21. Petejova N, Martinek A, Zahalkova J et al. Vancomycin pharmacokinetics during high‑volume continuous venovenous hemofiltration in criti­cally ill septic patients. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2014; 158: 65– 72. doi: 10.5507/ bp.2012.092.

22. Petejova N, Martinek A, Zahalkova J et al. Vancomycin removal during low‑ flux and high‑flux extended daily hemodialysis in critically ill septic patients. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2012; 156: 342– 347. doi: 10.5507/ bp.2012.002.

23. Petejová N, Martínek A, Zahálková J et al. Vliv kontinuální a intermitentní náhrady renálních funkcí na antibio­tickou léčbu u kriticky nemocných v sepsi –  praktický pohled na léčbu vankomycinem a gentamicinem. Vnitř Lék 2012; 58: 448– 454.

Labels
Paediatric cardiology Internal medicine Cardiac surgery Cardiology
Topics Journals
Login
Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.

Login

Don‘t have an account?  Create new account

#ADS_BOTTOM_SCRIPTS#