School of Biomedical Sciences, University of Leeds, Leeds LS2 9JT, UK.
Leeds Institute of Health Sciences, University of Leeds, Leeds LS2 9JT, UK.
J Antimicrob Chemother. 2022 May 29;77(6):1532-1541. doi: 10.1093/jac/dkac101.
Dosing regimens guided by therapeutic drug monitoring (TDM) may be able to improve penicillin exposure in patients, which could result in improved patient health outcomes.
This systematic review aims to describe the impact penicillin TDM has on health outcomes, including antimicrobial resistance (AMR).
Studies measuring penicillins in patient samples that adjusted regimens according to the result, and reported health outcomes were selected. Study bias was assessed according to study type. Included study characteristics were tabulated and described by narrative synthesis.
Three randomized controlled trials (RCTs), 16 cohort studies, and 9 case studies were included. No RCTs showed statistically significant improvements in health outcomes. Five cohort studies showed improvement in at least one health outcome associated with target attainment. However, there was a high risk of bias in all studies for health outcomes. One study assessed the impact of penicillin TDM on AMR and found that improved target attainment was associated with suppression of resistance. No studies found a detrimental effect of penicillin TDM.
There is little evidence to suggest that TDM improves health outcomes, however neither health outcomes nor impact on AMR were adequately addressed. Variations in TDM implementation meant that a meta-analysis was not suitable. Penicillin TDM needs standardization, however there is currently no clear evidence of optimal conditions. Suitably powered studies are required to resolve the ambiguity surrounding the impact of TDM on clinical outcomes, including AMR. Further, standardized protocols and concentration targets need to be identified for TDM to be implemented successfully.
通过治疗药物监测（TDM）指导的给药方案可能能够提高患者的青霉素暴露量，从而改善患者的健康结果。
本系统评价旨在描述青霉素 TDM 对健康结果的影响，包括抗菌药物耐药性（AMR）。
选择了测量患者样本中青霉素并根据结果调整方案、报告健康结果的研究。根据研究类型评估研究偏倚。纳入的研究特征以叙述性综合的方式进行列表和描述。
纳入了 3 项随机对照试验（RCT）、16 项队列研究和 9 项病例研究。没有 RCT 显示健康结果有统计学意义的改善。5 项队列研究表明，至少有一项与目标达成相关的健康结果得到了改善。然而，所有研究在健康结果方面都存在高度偏倚风险。一项研究评估了青霉素 TDM 对 AMR 的影响，发现目标达成的改善与耐药性的抑制有关。没有研究发现青霉素 TDM 有不良影响。
几乎没有证据表明 TDM 可以改善健康结果，但无论是健康结果还是对 AMR 的影响都没有得到充分解决。TDM 实施的差异意味着不适合进行荟萃分析。青霉素 TDM 需要标准化，但目前没有明确的最佳条件证据。需要进行有足够效力的研究，以解决 TDM 对临床结果（包括 AMR）影响的不确定性。此外，需要确定标准化的方案和浓度目标，以成功实施 TDM。
