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Therapeutisches Drugmonitoring und pharmakokinetische Modelle als Strategie zur rationalen Antibiotikatherapie bei IntensivpatientInnen

Therapeutic drug monitoring and pharmacokinetic models as a strategy for rational antibiotic therapy in intensive care patients

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Zusammenfassung

Hintergrund und Ziel der Arbeit

Die Dosierung von Antibiotika ist bei IntensivpatientInnen aufgrund pharmakokinetischer (PK-)Veränderungen komplex. Das Ziel des Beitrags ist es, den Stellenwert von therapeutischem Drugmonitoring (TDM) und PK-Modellen bei der Dosierungsindividualisierung von Antibiotika zu zeigen.

Material und Methoden

Hierfür werden Leitlinien und Empfehlungen im Kontext der klinischen Praxis erörtert und Voraussetzungen für ein routinemäßiges TDM der verschiedenen Antibiotika dargestellt. Zudem werden Nutzen und Limitationen des TDM erörtert. Die Vor- und Nachteile von TDM und PK-Modellen werden beschrieben und daraus resultierende Zukunftsoptionen präsentiert.

Ergebnisse

In der klinischen Routine kann der Spitzen- oder Talspiegel von Antibiotika, abhängig von ihrer Klasse, im Blut gemessen werden. Voraussetzungen für ein zielführendes TDM sind eine koordinierte Blutentnahme und eine zeitnahe Befundmitteilung. Da Zielbereiche regelhaft nicht einheitlich definiert sind, gestalten sich Dosierungsanpassungen schwierig. Die PK-Modelle bieten eine valide Möglichkeit, die Antibiotikatherapie von IntensivpatientInnen zu individualisieren. Anwendungsbereiche sind die Kalkulation der initialen Antibiotikadosis, aber auch die Kombination mit TDM zur Therapiesteuerung. Für wen und wie oft ein TDM notwendig ist, und wie es mit PK-Modellen bestmöglich kombiniert oder durch diese sogar ersetzt werden kann, sollte neben der Evaluation des optimalen Zielbereichs zukünftig untersucht werden.

Schlussfolgerung

Das routinemäßige TDM von Antibiotika bei IntensivpatientInnen ist nur unter oben genannten Voraussetzungen zielführend. Durch die Kombination mit PK-Modellen könnte die Therapie zukünftig optimiert werden.

Abstract

Background and objective

Antibiotic dosing in intensive care patients is complex due to pharmacokinetic (PK) alterations. The aim of this article is to illustrate the role of therapeutic drug monitoring (TDM) and PK models to individualize antibiotic dosing.

Material and methods

Guidelines and recommendations are discussed in the context of clinical practice and the prerequisites for routine TDM of different antibiotics are presented. In addition, the benefits and limitations of TDM are discussed. The advantages and disadvantages of TDM and PK models are described and the resulting future options are presented.

Results

In the clinical routine, the peak or trough concentrations of antibiotics in blood are measured depending on the antibiotic class. Prerequisites for a purposeful TDM are a coordinated blood sampling and a prompt reporting of findings. As target ranges are not uniformly defined following rules, dosage adjustments are difficult. The PK models offer a valid possibility to individualize the antibiotic therapy of intensive care patients. Areas of application are the calculation of the loading dose and the combination with TDM for treatment control. For whom and how often TDM is necessary and how it can best be combined with PK models or even replace them should be investigated in the future, in addition to evaluation of the optimal target area.

Conclusion

The routine use of TDM for antibiotics in intensive care patients is only effective under the abovementioned conditions. By combination with PK models the treatment could be optimized in the future.

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Authors and Affiliations

  1. Institut für Klinische Pharmazie, Westfälische Wilhelms-Universität Münster, Münster, Deutschland

    Lea Marie Schatz

  2. Klinik für Anästhesiologie, LMU Klinikum, Marchioninistr. 15, 81377, München, Deutschland

    Michael Zoller, Christina Scharf &  Uwe Liebchen

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  1. Lea Marie Schatz
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Correspondence to Uwe Liebchen.

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Interessenkonflikt

L.M. Schatz, M. Zoller, C. Scharf und U. Liebchen geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den AutorInnen keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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C. Scharf und U. Liebchen trugen zu gleichen Teilen zur vorliegenden Arbeit bei.

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Schatz, L.M., Zoller, M., Scharf, C. et al. Therapeutisches Drugmonitoring und pharmakokinetische Modelle als Strategie zur rationalen Antibiotikatherapie bei IntensivpatientInnen. Anaesthesiologie 71, 495–501 (2022). https://doi.org/10.1007/s00101-022-01150-7

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