From Therapeutic Drug Monitoring to Model‐Informed Precision Dosing for Antibiotics
Therapeutic drug monitoring (TDM) and model‐informed precision dosing (MIPD) have evolved as important tools to inform rational dosing of antibiotics in individual patients with infections. In particular, critically ill patients display altered, highly variable pharmacokinetics and often suffer from...
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| Vydané v: | Clinical pharmacology and therapeutics Ročník 109; číslo 4; s. 928 - 941 |
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| Hlavní autori: | , , , , , , |
| Médium: | Journal Article |
| Jazyk: | English |
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United States
01.04.2021
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| ISSN: | 0009-9236, 1532-6535, 1532-6535 |
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| Abstract | Therapeutic drug monitoring (TDM) and model‐informed precision dosing (MIPD) have evolved as important tools to inform rational dosing of antibiotics in individual patients with infections. In particular, critically ill patients display altered, highly variable pharmacokinetics and often suffer from infections caused by less susceptible bacteria. Consequently, TDM has been used to individualize dosing in this patient group for many years. More recently, there has been increasing research on the use of MIPD software to streamline the TDM process, which can increase the flexibility and precision of dose individualization but also requires adequate model validation and re‐evaluation of existing workflows. In parallel, new minimally invasive and noninvasive technologies such as microneedle‐based sensors are being developed, which—together with MIPD software—have the potential to revolutionize how patients are dosed with antibiotics. Nonetheless, carefully designed clinical trials to evaluate the benefit of TDM and MIPD approaches are still sparse, but are critically needed to justify the implementation of TDM and MIPD in clinical practice. The present review summarizes the clinical pharmacology of antibiotics, conventional TDM and MIPD approaches, and evidence of the value of TDM/MIPD for aminoglycosides, beta‐lactams, glycopeptides, and linezolid, for which precision dosing approaches have been recommended. |
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| AbstractList | Therapeutic drug monitoring (TDM) and model‐informed precision dosing (MIPD) have evolved as important tools to inform rational dosing of antibiotics in individual patients with infections. In particular, critically ill patients display altered, highly variable pharmacokinetics and often suffer from infections caused by less susceptible bacteria. Consequently, TDM has been used to individualize dosing in this patient group for many years. More recently, there has been increasing research on the use of MIPD software to streamline the TDM process, which can increase the flexibility and precision of dose individualization but also requires adequate model validation and re‐evaluation of existing workflows. In parallel, new minimally invasive and noninvasive technologies such as microneedle‐based sensors are being developed, which—together with MIPD software—have the potential to revolutionize how patients are dosed with antibiotics. Nonetheless, carefully designed clinical trials to evaluate the benefit of TDM and MIPD approaches are still sparse, but are critically needed to justify the implementation of TDM and MIPD in clinical practice. The present review summarizes the clinical pharmacology of antibiotics, conventional TDM and MIPD approaches, and evidence of the value of TDM/MIPD for aminoglycosides, beta‐lactams, glycopeptides, and linezolid, for which precision dosing approaches have been recommended. Therapeutic drug monitoring (TDM) and model-informed precision dosing (MIPD) have evolved as important tools to inform rational dosing of antibiotics in individual patients with infections. In particular, critically ill patients display altered, highly variable pharmacokinetics and often suffer from infections caused by less susceptible bacteria. Consequently, TDM has been used to individualize dosing in this patient group for many years. More recently, there has been increasing research on the use of MIPD software to streamline the TDM process, which can increase the flexibility and precision of dose individualization but also requires adequate model validation and re-evaluation of existing workflows. In parallel, new minimally invasive and noninvasive technologies such as microneedle-based sensors are being developed, which-together with MIPD software-have the potential to revolutionize how patients are dosed with antibiotics. Nonetheless, carefully designed clinical trials to evaluate the benefit of TDM and MIPD approaches are still sparse, but are critically needed to justify the implementation of TDM and MIPD in clinical practice. The present review summarizes the clinical pharmacology of antibiotics, conventional TDM and MIPD approaches, and evidence of the value of TDM/MIPD for aminoglycosides, beta-lactams, glycopeptides, and linezolid, for which precision dosing approaches have been recommended.Therapeutic drug monitoring (TDM) and model-informed precision dosing (MIPD) have evolved as important tools to inform rational dosing of antibiotics in individual patients with infections. In particular, critically ill patients display altered, highly variable pharmacokinetics and often suffer from infections caused by less susceptible bacteria. Consequently, TDM has been used to individualize dosing in this patient group for many years. More recently, there has been increasing research on the use of MIPD software to streamline the TDM process, which can increase the flexibility and precision of dose individualization but also requires adequate model validation and re-evaluation of existing workflows. In parallel, new minimally invasive and noninvasive technologies such as microneedle-based sensors are being developed, which-together with MIPD software-have the potential to revolutionize how patients are dosed with antibiotics. Nonetheless, carefully designed clinical trials to evaluate the benefit of TDM and MIPD approaches are still sparse, but are critically needed to justify the implementation of TDM and MIPD in clinical practice. The present review summarizes the clinical pharmacology of antibiotics, conventional TDM and MIPD approaches, and evidence of the value of TDM/MIPD for aminoglycosides, beta-lactams, glycopeptides, and linezolid, for which precision dosing approaches have been recommended. |
| Author | Wicha, Sebastian G. Minichmayr, Iris K. Märtson, Anne‐Grete Friberg, Lena E. Nielsen, Elisabet I. Koch, Birgit C.P. Alffenaar, Jan‐Willem |
| Author_xml | – sequence: 1 givenname: Sebastian G. surname: Wicha fullname: Wicha, Sebastian G. email: sebastian.wicha@uni-hamburg.de organization: University of Hamburg – sequence: 2 givenname: Anne‐Grete surname: Märtson fullname: Märtson, Anne‐Grete organization: University of Groningen – sequence: 3 givenname: Elisabet I. surname: Nielsen fullname: Nielsen, Elisabet I. organization: Uppsala University – sequence: 4 givenname: Birgit C.P. surname: Koch fullname: Koch, Birgit C.P. organization: University Medical Center Rotterdam – sequence: 5 givenname: Lena E. surname: Friberg fullname: Friberg, Lena E. organization: Uppsala University – sequence: 6 givenname: Jan‐Willem surname: Alffenaar fullname: Alffenaar, Jan‐Willem organization: Westmead Hospital – sequence: 7 givenname: Iris K. surname: Minichmayr fullname: Minichmayr, Iris K. organization: Uppsala University |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/33565627$$D View this record in MEDLINE/PubMed |
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