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Updated: Jul 9, 2026
11:17
Multiplex Therapeutic Drug Monitoring by Isotope-dilution HPLC-MS/MS of Antibiotics in Critical Illnesses
Published on: August 30, 2018
The ICU pharmacist's contribution to antimicrobial optimization through routine pharmacist interventions.
Natalia Sánchez-Ocaña1, Luis Pérez-de-Amezaga-Tomás2, Andres Giglio3,4,5,6,7
1Pharmacy Department, Hospital Clínico San Carlos, Madrid, Spain.
Summary
Critical care pharmacists (CCPs) identified numerous antimicrobial-related drug problems in the ICU. Proactive interventions, particularly dose adjustments for overdosing and underdosing, highlight the need for CCP integration into antimicrobial stewardship programs.
Area of Science:
- Pharmacology
- Intensive Care Medicine
- Drug Safety
Background:
- Antimicrobials are frequently implicated in medication errors and adverse drug events within Intensive Care Units (ICUs).
- The role of Critical Care Pharmacists (CCPs) in antimicrobial stewardship is supported by evidence, yet their integration into European ICU teams is inconsistent.
Purpose of the Study:
- To evaluate the impact of Critical Care Pharmacists (CCPs) on identifying and intervening in antimicrobial-related drug problems within an Intensive Care Unit (ICU).
- To characterize the types and frequency of pharmaceutical interventions related to antimicrobial therapy.
Main Methods:
- A prospective observational study was conducted over five months in a medical-surgical ICU.
- A specialist pharmacist prospectively reviewed daily antimicrobial prescriptions via an electronic system.
- Pharmaceutical interventions (PIs) were classified as proactive or reactive and categorized by type.
Main Results:
- A total of 331 PIs were recorded, with 150 (45.31%) related to antimicrobial therapy, making it the most common medication group involved.
- Antimicrobial-related PIs averaged 1.50 per working day, with 76.67% being proactive.
- The most frequent interventions involved dose adjustments for overdosing (47.33%) and underdosing (18.00%), alongside therapeutic drug monitoring and drug information.
Conclusions:
- Critical Care Pharmacists (CCPs) effectively identify a significant number of antimicrobial-related drug issues in the ICU through routine prospective review.
- The prevalence of both overdosing and underdosing interventions underscores the pharmacokinetic challenges in critically ill patients.
- These findings advocate for the formal integration of CCPs into ICU antimicrobial stewardship initiatives.
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