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Updated: Jul 1, 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]
Abstract:
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
Monitoring antimicrobial drug levels in critically ill patients improves outcomes. New guidelines aim to standardize this process for better drug effectiveness and safety across hospitals.
Area of Science:
- Pharmacokinetics and Pharmacodynamics
- Clinical Pharmacy
- Infectious Diseases
Context:
- Plasma concentration monitoring of antimicrobial agents is recommended for critically ill patients.
- Current practice primarily focuses on vancomycin and aminoglycosides, limiting broader application.
- Variability in monitoring techniques hinders result interpretation and comparison.
Purpose:
- To establish standardized recommendations for monitoring plasma antimicrobial concentrations.
- To create a homogeneous process for multicenter studies and data comparison.
- To guide best practices in drug level monitoring for improved patient care.
Summary:
- Guidelines address all aspects of antimicrobial monitoring: test indications, blood sampling, laboratory transport, analytical techniques, reference ranges, and dose adjustments.
- Recommendations are based on 14 key questions to ensure a comprehensive approach.
- Vancomycin and aminoglycosides serve as reference agents for the proposed monitoring standards.
Impact:
- Facilitate multicenter studies by enabling consistent data interpretation.
- Enhance the reliability and comparability of antimicrobial drug monitoring results.
- Improve clinical outcomes by optimizing antimicrobial therapy effectiveness and safety.
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