• Mohd H Abdul-Aziz, AlffenaarJan-Willem CJCSchool of Pharmacy, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.Westmead Hospital, Westmead, NSW, Australia.Marie Bashir Institute of Infectious Diseases and Biosecurity, University of Sydney, Sydney, Matteo Bassetti, Hendrik Bracht, George Dimopoulos, Deborah Marriott, Michael N Neely, Jose-Artur Paiva, Federico Pea, Fredrik Sjovall, Jean F Timsit, Andrew A Udy, Sebastian G Wicha, Markus Zeitlinger, Jan J De Waele, Jason A Roberts, Infection Section of European Society of Intensive Care Medicine (ESICM), Pharmacokinetic/pharmacodynamic and Critically Ill Patient Study Groups of European Society of Clinical Microbiology and Infectious Diseases (ESCMID), Infectious Diseases Group of International Association of Therapeutic Drug Monitoring and Clinical Toxicology (IATDMCT), and Infections in the ICU and Sepsis Working Group of International Society of Antimicrobial Chemotherapy (ISAC).
• University of Queensland Centre for Clinical Research (UQCCR), Faculty of Medicine, The University of Queensland, Brisbane, QLD, 4029, Australia.
• Intensive Care Med. 2020 Jun 1; 46 (6): 1127-1153.

PurposeThis Position Paper aims to review and discuss the available data on therapeutic drug monitoring (TDM) of antibacterials, antifungals and antivirals in critically ill adult patients in the intensive care unit (ICU). This Position Paper also provides a practical guide on how TDM can be applied in routine clinical practice to improve therapeutic outcomes in critically ill adult patients.MethodsLiterature review and analysis were performed by Panel Members nominated by the endorsing organisations, European Society of Intensive Care Medicine (ESICM), Pharmacokinetic/Pharmacodynamic and Critically Ill Patient Study Groups of European Society of Clinical Microbiology and Infectious Diseases (ESCMID), International Association for Therapeutic Drug Monitoring and Clinical Toxicology (IATDMCT) and International Society of Antimicrobial Chemotherapy (ISAC). Panel members made recommendations for whether TDM should be applied clinically for different antimicrobials/classes.ResultsTDM-guided dosing has been shown to be clinically beneficial for aminoglycosides, voriconazole and ribavirin. For most common antibiotics and antifungals in the ICU, a clear therapeutic range has been established, and for these agents, routine TDM in critically ill patients appears meritorious. For the antivirals, research is needed to identify therapeutic targets and determine whether antiviral TDM is indeed meritorious in this patient population. The Panel Members recommend routine TDM to be performed for aminoglycosides, beta-lactam antibiotics, linezolid, teicoplanin, vancomycin and voriconazole in critically ill patients.ConclusionAlthough TDM should be the standard of care for most antimicrobials in every ICU, important barriers need to be addressed before routine TDM can be widely employed worldwide.

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