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Updated: Jul 6, 2026

Multiplex Therapeutic Drug Monitoring by Isotope-dilution HPLC-MS/MS of Antibiotics in Critical Illnesses
Published on: August 30, 2018
[Recommendations for antibiotic monitoring in ICU patients]
Francisco Alvarez-Lerma1, Pedro Olaechea, Santiago Grau
1Servicio de Medicina Intensiva, Hospital del Mar, Barcelona, España. Falvarez@imas.imim.es
Unlabelled:
Monitoring plasma concentrations of antimicrobial agents used to treat infection in critically ill patients is one of the recommended strategies for improving clinical outcome. Drug monitoring has a double
Aim:
to limit adverse events and to increase the effectiveness of the drugs. In clinical practice, however, this approach is mainly limited to monitoring plasma concentrations of vancomycin and aminoglycosides, although future extension to other antimicrobial agents would be desirable. Application of this technique varies considerably between hospitals, and this makes interpretation and comparison of the results obtained difficult. For this reason, representatives of various scientific societies related to the pharmacokinetic area have developed a series of recommendations for monitoring plasma concentrations of antimicrobials using vancomycin and several aminoglycosides as the reference. The recommendations are based on 14 questions encompassing all steps of the process: indication for the test, blood sampling (timing of blood collection, blood volume, tubes), transport to the laboratory, techniques applied, normal values, dose adjustment, and reporting the
Results:
The purpose of these guidelines is to develop a process of monitoring plasma antimicrobial concentrations that is as homogeneous as possible to facilitate the design of multicenter studies, as well as the interpretation and comparison of results.
Insights
Therapeutic drug monitoring for antimicrobial agents in critically ill patients improves outcomes. These guidelines standardize antimicrobial drug monitoring to enhance clinical results and facilitate multicenter research.
Area of Science:
- Pharmacokinetics and Pharmacodynamics
- Infectious Diseases
- Critical Care Medicine
Context:
- Plasma concentration monitoring of antimicrobial agents is recommended for critically ill patients.
- Current practice is limited to vancomycin and aminoglycosides, with variability between institutions.
- Standardization is needed for effective interpretation and comparison of drug monitoring results.
Purpose:
- To establish standardized recommendations for monitoring plasma antimicrobial concentrations.
- To create a homogeneous process for drug monitoring across different healthcare settings.
- To facilitate multicenter studies and improve the interpretation of results.
Summary:
- Developed guidelines based on 14 questions covering the entire drug monitoring process.
- Recommendations address test indications, blood sampling, laboratory transport, techniques, normal values, dose adjustment, and reporting.
- Focuses on vancomycin and aminoglycosides as reference agents for standardization.
Impact:
- Aims to limit adverse events and increase antimicrobial drug effectiveness.
- Enhances the consistency and comparability of therapeutic drug monitoring data.
- Supports improved clinical outcomes and facilitates collaborative research in antimicrobial pharmacotherapy.
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