Individualizing beta-lactam dosing in real-world patients: lessons from a pharmacist-led programme implementation and...

Area of Science:

• Pharmacology
• Infectious Diseases
• Clinical Pharmacy

Background:

• Individualized dosing of beta-lactam antibiotics using serum concentrations is an emerging strategy to manage pharmacokinetic/pharmacodynamic (PK/PD) variability.
• This approach aims to optimize therapeutic outcomes in specific patient populations.

Purpose of the Study:

• To describe a beta-lactam dose individualization program.
• To highlight the successes and challenges encountered during its implementation.
• To evaluate the effectiveness of pharmacist-driven serum concentration monitoring.

Main Methods:

• A single-centre evaluation of a pharmacist-driven beta-lactam dosing protocol was conducted.
• Serum concentrations of cefepime, meropenem, or piperacillin-tazobactam were monitored using Bayesian software.
• Data collected included drug monitored, indication, model fitness, therapy alterations, protocol adherence, and PK/PD attainment.

Main Results:

• Eighty-two serum levels were analyzed in 47 patients, with cefepime being the most frequently monitored drug.
• Dose or agent optimization was feasible in 60% of cases, leading to dose adjustments in 34%.
• Therapeutic targets (100% fT>1xMIC, 61.7% fT>4xMIC) were achieved in most patients, but protocol deviations (57.4%) and high troughs (>20%) were noted.

Conclusions:

• Beta-lactam dose individualization via serum concentration monitoring is effective, enabling optimization in over 50% of patients.
• Pharmacist involvement is crucial for dose adjustments, but protocol adherence requires improvement through education.
• The program demonstrated success in achieving PK/PD targets while identifying areas for enhanced implementation.