Infect Chemother.  2008 Jun;40(3):133-139. 10.3947/ic.2008.40.3.133.

Therapeutic Drug Monitoring (TDM) of Antimicrobial Agents

Affiliations
  • 1Department of Internal Medicine, School of Medicine, Kyungpook National University College of Medicine, Daegu, Korea. ksw2kms@knu.ac.kr

Abstract

Optimal exposure of certain antimicrobials and minimization of their toxicity can be achieved by therapeutic drug monitoring (TDM) of antimicrobial agents. Vancomycin and aminoglycosides are most frequently monitored because of narrow therapeutic index and potential adverse effects. The rationale of TDM based on the individual variability in pharmacokinetics (PK) and established correlation between the concentration of the drug and its therapeutic or toxic effects. Benefits of TDM are well established with many studies, the usefulness of antimicrobial TDM for the patients with risk factors of adverse effects (nephrotoxicity and ototoxicity of aminoglycoside and vancomycin) and with treatment failure or severe infection have to be emphasized. With the recent knowledge of PK and pharmacodynamics (PD), interpretation of TDM could be performed with individual PK/PD in regarding to minimal inhibitory concentration (MIC) of specific identified organism or MIC90 of suspected pathogen.

Keyword

Therapeutic drug monitoring; Antimicrobials; Vancomycin; Aminoglycosides; Pharmacokinetics; Pharmacodynamics

MeSH Terms

Aminoglycosides
Anti-Infective Agents
Drug Monitoring
Humans
Risk Factors
Treatment Failure
Vancomycin
Aminoglycosides
Anti-Infective Agents
Vancomycin

Figure

  • Fig. 1 Utility curve and concentration-effect/toxicity relationships for a theoretical drug according to Eq (E=Emax·Cs/(Cs+EC50s). EC50 for efficacy=10 mg/L, EC50 for toxicity=60 mg/L, thus the therapeutic index is 6; s=1.0 (7).

  • Fig. 2 Schematic diagram of attaining steady state concentration of a certain drug. The time required to reach steady state is approximately 4-5 half-lives. Time to steady state is independent of dosage.

  • Fig. 3 Once-daily aminoglycoside nomogram for the assessment of dosing interval using a 7 mg/kg dose of gentamicin or tobramycin (45).


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