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Therapeutic Drug Monitoring (TDM) of Antimicrobial Agents
Shin-Woo Kim, M.D.
Department of Internal Medicine, School of Medicine, Kyungpook National University College of Medicine, Daegu, Korea
Vol.40 Num.3 (p133~139)
Optimal exposure of certain antimicrobials and minimization of their toxicity can be achieved by therapeutic drug monitoring (TDM) of antimicrobial agents. Vancomycin and aminoglycosides are most frequently monitored because of narrow therapeutic index and potential adverse effects. The rationale of TDM based on the individual variability in pharmacokinetics (PK) and established correlation between the concentration of the drug and its therapeutic or toxic effects. Benefits of TDM are well established with many studies, the usefulness of antimicrobial TDM for the patients with risk factors of adverse effects (nephrotoxicity and ototoxicity of aminoglycoside and vancomycin) and with treatment failure or severe infection have to be emphasized. With the recent knowledge of PK and pharmacodynamics (PD), interpretation of TDM could be performed with individual PK/PD in regarding to minimal inhibitory concentration (MIC) of specific identified organism or MIC90 of suspected pathogen.
Keywords : Therapeutic drug monitoring, Antimicrobials, Vancomycin, Aminoglycosides, Pharmacokinetics, Pharmacodynamics