• Mieke Carlier, Veronique Stove, Steven C Wallis, Jan J De Waele, Alain G Verstraete, Jeffrey Lipman, and Jason A Roberts.
• Department of Clinical Chemistry, Microbiology and Immunology, Ghent University, Ghent, Belgium; Department of Critical Care Medicine, Ghent University, Ghent, Belgium. Electronic address: mieke.carlier@ugent.be.
• Int. J. Antimicrob. Agents. 2015 Oct 1; 46 (4): 367-75.

AbstractIn some patient groups, including critically ill patients, the pharmacokinetics of β-lactam antibiotics may be profoundly disturbed due to pathophysiological changes in distribution and elimination. Therapeutic drug monitoring (TDM) is a strategy that may help to optimise dosing. The aim of this review was to identify and analyse the published literature on the methods used for β-lactam quantification in TDM programmes. Sixteen reports described methods for the simultaneous determination of three or more β-lactam antibiotics in plasma/serum. Measurement of these antibiotics, due to low frequency of usage relative to some other tests, is generally limited to in-house chromatographic methods coupled to ultraviolet or mass spectrometric detection. Although many published methods state they are fit for TDM, they are inconvenient because of intensive sample preparation and/or long run times. Ideally, methods used for routine TDM should have a short turnaround time (fast run-time and fast sample preparation), a low limit of quantification and a sufficiently high upper limit of quantification. The published assays included a median of 6 analytes [interquartile range (IQR) 4-10], with meropenem and piperacillin being the most frequently measured β-lactam antibiotics. The median run time was 8 min (IQR 5.9-21.3 min). There is also a growing number of methods measuring free concentrations. An assay that measures antibiotics without any sample preparation would be the next step towards real-time monitoring; no such method is currently available.Copyright © 2015 Elsevier B.V. and the International Society of Chemotherapy. All rights reserved.

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