Therapeutic Drug Monitoring

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Therapeutic Drug Monitoring:
doi: 10.1097/FTD.0b013e31824981a6
Original Article

Therapeutic Drug Monitoring of Beta-Lactam Antibiotics in Burns Patients—A One-Year Prospective Study

Patel, Bhavik M. MBBS, MS*,†; Paratz, Jennifer PhD, FACP, MPhty*,‡; See, Natalie C. MBBS*; Muller, Michael J. MBBS, MMedSci, FRACS*,†; Rudd, Michael MBBS, PhD, FRACS*,†; Paterson, David MBBS, PhD, FRACP, FRCPA§; Briscoe, Scott E. MSc; Ungerer, Jacobus FRCPA; McWhinney, Brett C. MPhil, MBA, FFSc(RCPA); Lipman, Jeffrey MBBCh, FCICM, MD*,‡; Roberts, Jason A. PhD, FSHP*,‡

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Background: Beta-lactams are first-line antibiotics for the management of superficial infections due to burn injury. There is sparse data available on therapeutic drug monitoring (TDM) in patients with burns in a ward setting. This study was conducted to evaluate the utility of a beta-lactam TDM program in a cohort of burn injury patients in a ward environment.

Methods: Steady-state blood samples were collected immediately before a scheduled dose. The therapeutic concentration targets assessed were (1) free antibiotic concentrations exceeding the minimum inhibitory concentration (MIC; fT > MIC) and (2) free concentrations ≥4× MIC of the known or suspected pathogen (fT > 4× MIC). The duration of therapy was also assessed.

Results: A total of 50 patients were included for TDM over a 12-month period. The mean (±SD) age was 49 ± 16 years. The mean percent total body surface area burn was 17 ± 13%. The mean serum creatinine concentration was 86 ± 20 μmole/L. Sixty percent of the patients did not achieve fT > MIC, and only 18% achieved the higher target of fT > 4× MIC. Although all the patients achieved a positive clinical outcome, the duration of antibiotic treatment was shorter in patients who achieved fT > MIC compared with those who did not (4.2 ± 1.1 versus 5.3 ± 2.3 days; P = 0.03).

Conclusions: We found TDM to be a reliable intervention for burn injury patients in a ward environment. This study supports pharmacokinetic data that burns patients may be at risk of subtherapeutic dosing, which may prolong the duration of antibiotic therapy.

© 2012 Lippincott Williams & Wilkins, Inc.


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