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Multiplex Therapeutic Drug Monitoring by Isotope-dilution HPLC-MS/MS of Antibiotics in Critical Illnesses
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Multiplex Therapeutic Drug Monitoring by Isotope-dilution HPLC-MS/MS of Antibiotics in Critical Illnesses

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[Therapeutic monitoring of amikacin and gentamicin in routine clinical practice]

Ivana Kacířová, Milan Grundmann

    Vnitrni Lekarstvi
    |February 20, 2015
    PubMed

    Insights

    Aminoglycosides are effective antimicrobials, but can be toxic. Extended interval dosing reduces toxicity and improves outcomes, with therapeutic drug monitoring optimizing their use.

    Area of Science:

    • Pharmacology
    • Infectious Diseases
    • Clinical Pharmacy

    Background:

    • Aminoglycosides are essential antimicrobials for aerobic gram-negative infections and synergistic gram-positive therapy.
    • Despite known nephrotoxicity and ototoxicity, their clinical value persists.
    • These agents exhibit concentration-dependent bactericidal effects and a notable post-antibiotic effect.

    Purpose of the Study:

    • To review the efficacy and toxicity of aminoglycosides.
    • To highlight the benefits of extended interval dosing.
    • To emphasize the role of therapeutic drug monitoring in optimizing aminoglycoside therapy.

    Main Methods:

    • Literature review of aminoglycoside pharmacology, clinical use, and toxicity.
    • Analysis of evidence supporting extended interval dosing strategies.
    • Discussion of therapeutic drug monitoring principles for aminoglycosides.

    Main Results:

    • Extended interval dosing of aminoglycosides is associated with reduced nephrotoxicity and ototoxicity.
    • Clinical outcomes with extended interval dosing are comparable or superior to traditional multiple daily dosing.
    • Aminoglycoside efficacy and toxicity are directly related to blood drug concentrations.

    Conclusions:

    • Extended interval dosing represents an optimized strategy for aminoglycoside administration.
    • Therapeutic drug monitoring is crucial for minimizing aminoglycoside toxicity and maximizing efficacy.
    • Aminoglycosides remain valuable agents when administered and monitored appropriately.

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