From Therapeutic Drug Monitoring to Model-Informed Precision Dosing for Antibiotics

Sebastian G. Wicha*, the International Society of Anti-Infective Pharmacology (ISAP), the PK/PD study group of the European Society of Clinical Microbiology, Infectious Diseases (EPASG)

*Corresponding author for this work

Research output: Contribution to journalReview articleAcademicpeer-review

128 Citations (Scopus)
149 Downloads (Pure)

Abstract

Therapeutic drug monitoring (TDM) and model-informed precision dosing (MIPD) have evolved as important tools to inform rational dosing of antibiotics in individual patients with infections. In particular, critically ill patients display altered, highly variable pharmacokinetics and often suffer from infections caused by less susceptible bacteria. Consequently, TDM has been used to individualize dosing in this patient group for many years. More recently, there has been increasing research on the use of MIPD software to streamline the TDM process, which can increase the flexibility and precision of dose individualization but also requires adequate model validation and re-evaluation of existing workflows. In parallel, new minimally invasive and noninvasive technologies such as microneedle-based sensors are being developed, which—together with MIPD software—have the potential to revolutionize how patients are dosed with antibiotics. Nonetheless, carefully designed clinical trials to evaluate the benefit of TDM and MIPD approaches are still sparse, but are critically needed to justify the implementation of TDM and MIPD in clinical practice. The present review summarizes the clinical pharmacology of antibiotics, conventional TDM and MIPD approaches, and evidence of the value of TDM/MIPD for aminoglycosides, beta-lactams, glycopeptides, and linezolid, for which precision dosing approaches have been recommended.

Original languageEnglish
Pages (from-to)928-941
Number of pages14
JournalClinical Pharmacology and Therapeutics
Volume109
Issue number4
DOIs
Publication statusPublished - Apr 2021

Bibliographical note

Funding:
A.-G.M. was funded by Marie Skłodowska-Curie Actions (grant agreement no. 713660— PRONKJEWAIL—H2020-MSCA-COFUND −2015).

Publisher Copyright:
© 2021 The Authors. Clinical Pharmacology & Therapeutics published by Wiley Periodicals LLC on behalf of American Society for Clinical Pharmacology and Therapeutics.

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