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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*,‡

doi: 10.1097/FTD.0b013e31824981a6
Original Article

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.

*Burns, Trauma, and Critical Care Research Centre, The University of Queensland, Brisbane, Australia

Division of General Surgery and Burns

Department of Intensive Care Medicine

§University of Queensland Centre for Clinical Research

Pathology Queensland, Royal Brisbane and Women's Hospital, Brisbane, Australia.

The authors declare no conflict of interest.

Correspondence: Bhavik M. Patel, MBBS, MS, Burns, Trauma, and Critical Care Research Centre, School of Medicine, The University of Queensland, Level 3 Ned Hanlon Building, Royal Brisbane and Women's Hospital, Butterfield St, Herston, Brisbane, Queensland, Australia (e-mail:

Received October 24, 2011

Accepted January 4, 2012

© 2012 Lippincott Williams & Wilkins, Inc.