University of Queensland Centre for Clinical Research (UQCCR), Faculty of Medicine, The University of Queensland, Brisbane, QLD, 4029, Australia.
School of Pharmacy, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.
Intensive Care Med. 2020 Jun;46(6):1127-1153. doi: 10.1007/s00134-020-06050-1. Epub 2020 May 7.
This Position Paper aims to review and discuss the available data on therapeutic drug monitoring (TDM) of antibacterials, antifungals and antivirals in critically ill adult patients in the intensive care unit (ICU). This Position Paper also provides a practical guide on how TDM can be applied in routine clinical practice to improve therapeutic outcomes in critically ill adult patients.
Literature review and analysis were performed by Panel Members nominated by the endorsing organisations, European Society of Intensive Care Medicine (ESICM), Pharmacokinetic/Pharmacodynamic and Critically Ill Patient Study Groups of European Society of Clinical Microbiology and Infectious Diseases (ESCMID), International Association for Therapeutic Drug Monitoring and Clinical Toxicology (IATDMCT) and International Society of Antimicrobial Chemotherapy (ISAC). Panel members made recommendations for whether TDM should be applied clinically for different antimicrobials/classes.
TDM-guided dosing has been shown to be clinically beneficial for aminoglycosides, voriconazole and ribavirin. For most common antibiotics and antifungals in the ICU, a clear therapeutic range has been established, and for these agents, routine TDM in critically ill patients appears meritorious. For the antivirals, research is needed to identify therapeutic targets and determine whether antiviral TDM is indeed meritorious in this patient population. The Panel Members recommend routine TDM to be performed for aminoglycosides, beta-lactam antibiotics, linezolid, teicoplanin, vancomycin and voriconazole in critically ill patients.
Although TDM should be the standard of care for most antimicrobials in every ICU, important barriers need to be addressed before routine TDM can be widely employed worldwide.
本立场文件旨在回顾和讨论重症监护病房（ICU）成人危重症患者抗菌药物、抗真菌药物和抗病毒药物治疗药物监测（TDM）的现有数据。本立场文件还提供了关于如何在常规临床实践中应用 TDM 以改善成人危重症患者治疗效果的实用指南。
由欧洲重症监护医学学会（ESICM）、欧洲临床微生物学和传染病学会（ESCMID）药代动力学/药效学和危重症患者研究小组、国际治疗药物监测和临床毒理学协会（IATDMCT）和国际抗菌化疗学会（ISAC）提名的小组成员对文献进行了审查和分析。小组成员就不同的抗菌药物/类别是否应在临床上应用 TDM 提出了建议。
TDM 指导下的剂量调整已被证明对氨基糖苷类、伏立康唑和利巴韦林具有临床益处。对于 ICU 中最常见的抗生素和抗真菌药物，已经建立了明确的治疗范围，对于这些药物，在危重症患者中常规 TDM 似乎是有益的。对于抗病毒药物，需要进行研究以确定治疗靶点，并确定在该患者人群中进行抗病毒 TDM 是否确实有益。小组成员建议在 ICU 中对危重症患者常规进行氨基糖苷类、β-内酰胺类抗生素、利奈唑胺、替考拉宁、万古霉素和伏立康唑的 TDM。
尽管 TDM 应该成为每个 ICU 中大多数抗菌药物的标准治疗方法，但在全球范围内广泛采用常规 TDM 之前，需要解决重要的障碍。
