医学
抗菌管理
治疗药物监测
重症监护医学
头孢吡肟
美罗培南
哌拉西林
处方集
万古霉素
伏立康唑
药效学
药方
药理学
药品
药代动力学
抗生素
抗生素耐药性
亚胺培南
金黄色葡萄球菌
铜绿假单胞菌
细菌
抗真菌
微生物学
生物
遗传学
皮肤病科
作者
João Paulo Telles,Ronaldo Morales,Carolina Hikari Yamada,Tatiana Aporta Marins,Vanessa D'Amaro Juodinis,Konstantinos Syrigos,Moacyr Silva,Bil Randerson Bassetti,James Albiero,Felipe Francisco Tuon
出处
期刊:Therapeutic Drug Monitoring
[Ovid Technologies (Wolters Kluwer)]
日期:2023-01-02
卷期号:45 (2): 200-208
被引量:13
标识
DOI:10.1097/ftd.0000000000001067
摘要
Antimicrobial stewardship programs are important for reducing antimicrobial resistance because they can readjust antibiotic prescriptions to local guidelines, switch intravenous to oral administration, and reduce hospitalization times. Pharmacokinetics-pharmacodynamics (PK-PD) empirically based prescriptions and therapeutic drug monitoring (TDM) programs are essential for antimicrobial stewardship, but there is a need to fit protocols according to cost benefits. The cost benefits can be demonstrated by reducing toxicity and hospital stay, decreasing the amount of drug used per day, and preventing relapses in infection. Our aim was to review the data available on whether PK-PD empirically based prescriptions and TDM could improve the cost benefits of an antimicrobial stewardship program to decrease global hospital expenditures.A narrative review based on PubMed search with the relevant studies of vancomycin, aminoglycosides, beta-lactams, and voriconazole.TDM protocols demonstrated important cost benefit for patients treated with vancomycin, aminoglycosides, and voriconazole mainly due to reduce toxicities and decreasing the hospital length of stay. In addition, PK-PD strategies that used infusion modifications to meropenem, piperacillin-tazobactam, ceftazidime, and cefepime, such as extended or continuous infusion, demonstrated important cost benefits, mainly due to reducing daily drug needs and lengths of hospital stays.TDM protocols and PK-PD empirically based prescriptions improve the cost-benefits and decrease the global hospital expenditures.
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