Therapeutisches Drug Monitoring von Antiinfektiva bei Intensivpatienten – für welche Arzneistoffe und wie?

Was ist neu?

Prinzip des therapeutischen Drug Monitorings Für immer mehr Antiinfektiva gibt es Erkenntnisse zur Expositions-Wirkungs-Beziehung, die im therapeutischen Drug Monitoring (TDM) genutzt werden können. Dabei spielt die Schätzung der AUC (area under the curve) eine wichtige Rolle. Eine spezielle Pharmakokinetik-Software hilft in der Praxis, die Schätzung der AUC auch anhand weniger Proben zu ermöglichen.

Für welche Arzneistoffe wird ein therapeutisches Drug Monitoring empfohlen? Neben dem vielfach bereits etablierten TDM für Aminoglykoside (Amikacin, Gentamicin und Tobramycin) und Glykopeptide (Vancomycin, Teicoplanin) empfiehlt ein fachübergreifendes Expertengremium bei Intensivpatienten ein TDM für Betalaktame, Linezolid und Voriconazol. Neuerungen gibt es auch bei Vancomycin, bei dem vom häufig praktizierten „Talspiegel“-TDM zum in klinischen Studien überlegenen AUC-basierten TDM übergegangen werden soll.

Abstract

Pharmacokinetic and pharmacodynamic changes in intensive care unit patients can increase the risk for therapeutic failure or adverse effects of anti-infective therapy. Therapeutic drug monitoring (TDM) can inform required dose adaptions. The present article reviews the current practice and outlines modern approaches for decision making such as model-informed precision dosing software using the area-under-the-concentration-time-curve as target in favor of simplistic decision making based on trough concentrations. Moreover, the current recommendations for performing TDM of beta-lactams, aminoglycosides, linezolid, glycopeptides and voriconazole are concisely summarized.

Schlüsselwörter

Dosierung - therapeutisches Drug Monitoring - Antibiotika - Pharmakokinetik - Pharmakodynamik

Key words

dosing - therapeutic drug monitoring - antibiotics - pharmacokinetics - pharmacodynamics

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