Beta-lactam antibiotics remain one of the most preferred groups of antibiotics in critical care due to their excellent safety profiles and their activity against a wide spectrum of pathogens. The cornerstone of appropriate therapy with beta-lactams is to achieve an adequate plasmatic concentration of a given antibiotic, which is derived primarily from the minimum inhibitory concentration (MIC) of the specific pathogen. In a critically ill patient, the plasmatic levels of drugs could be affected by many significant changes in the patient's physiology, such as hypoalbuminemia, endothelial dysfunction with the leakage of intravascular fluid into interstitial space and acute kidney injury. Predicting antibiotic concentration from models based on non-critically ill populations may be misleading. Therapeutic drug monitoring (TDM) has been shown to be effective in achieving adequate concentrations of many drugs, including beta-lactam antibiotics. Reliable methods, such as high-performance liquid chromatography, provide the accurate testing of a wide range of beta-lactam antibiotics. Long turnaround times remain the main drawback limiting their widespread use, although progress has been made recently in the implementation of different novel methods of antibiotic testing. However, whether the TDM approach can effectively improve clinically relevant patient outcomes must be proved in future clinical trials.

2nd Department of Anaesthesiology University Hospital Brno 620 00 Brno Czech Republic

Department of Anaesthesiology and Intensive Care Medicine Faculty of Medicine University Hospital Brno Masaryk University 625 00 Brno Czech Republic

Department of Clinical Pharmacy Hospital Pharmacy University Hospital Brno 625 00 Brno Czech Republic

Department of Internal Medicine and Cardiology Faculty of Medicine University Hospital Brno Masaryk University 625 00 Brno Czech Republic

Department of Laboratory Medicine Division of Clinical Biochemistry University Hospital Brno 625 00 Brno Czech Republic

Department of Laboratory Methods Faculty of Medicine Masaryk University 625 00 Brno Czech Republic

Department of Paediatric Anaesthesiology and Intensive Care Medicine Faculty of Medicine University Hospital Brno Masaryk University 662 63 Brno Czech Republic

Department of Pharmacology Faculty of Medicine Masaryk University 625 00 Brno Czech Republic

Department of Simulation Medicine Faculty of Medicine Masaryk University 625 00 Brno Czech Republic

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$a Update on Therapeutic Drug Monitoring of Beta-Lactam Antibiotics in Critically Ill Patients-A Narrative Review / $c J. Stašek, F. Keller, V. Kočí, J. Klučka, E. Klabusayová, O. Wiewiorka, Z. Strašilová, M. Beňovská, M. Škardová, J. Maláska

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$a Beta-lactam antibiotics remain one of the most preferred groups of antibiotics in critical care due to their excellent safety profiles and their activity against a wide spectrum of pathogens. The cornerstone of appropriate therapy with beta-lactams is to achieve an adequate plasmatic concentration of a given antibiotic, which is derived primarily from the minimum inhibitory concentration (MIC) of the specific pathogen. In a critically ill patient, the plasmatic levels of drugs could be affected by many significant changes in the patient's physiology, such as hypoalbuminemia, endothelial dysfunction with the leakage of intravascular fluid into interstitial space and acute kidney injury. Predicting antibiotic concentration from models based on non-critically ill populations may be misleading. Therapeutic drug monitoring (TDM) has been shown to be effective in achieving adequate concentrations of many drugs, including beta-lactam antibiotics. Reliable methods, such as high-performance liquid chromatography, provide the accurate testing of a wide range of beta-lactam antibiotics. Long turnaround times remain the main drawback limiting their widespread use, although progress has been made recently in the implementation of different novel methods of antibiotic testing. However, whether the TDM approach can effectively improve clinically relevant patient outcomes must be proved in future clinical trials.

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