Therapeutisches Drug Monitoring (TDM) von Antiinfektiva in der Intensivmedizin

 

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Zusammenfassung

Das Therapeutische Drug-Monitoring (TDM) beruht auf der quantitativen Arzneimittelbestimmung in unterschiedlichen Materialien (Vollblut, Serum und Plasma, Bronchiallavage) und dient der Individualisierung der Arzneimitteltherapie und -sicherheit. Insbesondere im Bereich der Intensivstation werden die Wirkspiegel von Antibiotika durch Komorbidität, physiologische Veränderungen sowie gegenseitige Wechselwirkungen stark verändert. Die zentralen pharmakologischen Parameter Halbwertszeit (t_1/2), Bioverfügbarkeit (F) oder auch die Clearance (Cl) werden durch verschiedenste Faktoren beeinflusst. Ziel des TDM ist es, die Polypharmakotherapie des intensivmedizinisch versorgten Patienten individuell einzuschätzen und auf der Basis relevanter pharmakokinetischer Kenngrößen valide Dosisempfehlungen auszusprechen. Das TDM ist ein diagnostischer Standard für die Individualisierung der Arzneimitteltherapie auf der Grundlage von validierten Methoden (v. a. LC-MS/MS und HPLC-Methoden) zur Arzneimittelbestimmung im Blut mit dem Ziel, Dosierung und Arzneimittelsicherheit zu optimieren.

Abstract

Therapeutic Drug Monitoring (TDM) is based on drug-level control in biological matrices and serves as a diagnostic approach for individualization of pharmacotherapy and drug safety. Drug levels of antibiotics are distinctly influenced by comorbidity, physiological changes and various concomitant drugs in patients on intensive care units. Several factors should be taken into account for calculation of relevant pharmacokinetic parameters (elimination half-life, bioavailability, and clearance) to deduce a recommendation for dosage. TDM is a diagnostic standard for the individualization of polypharmcotherapy based on validated analytical methods (in particular LC-MS/MS and HPLC-methods) in order to optimize dosing and drug safety.

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