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A systematic review of the effect of therapeutic drug monitoring on patient health outcomes during treatment with penicillins

BACKGROUND: Dosing regimens guided by therapeutic drug monitoring (TDM) may be able to improve penicillin exposure in patients, which could result in improved patient health outcomes. OBJECTIVES: This systematic review aims to describe the impact penicillin TDM has on health outcomes, including anti...

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Autores principales: Luxton, Timothy, King, Natalie, Wälti, Christoph, Jeuken, Lars, Sandoe, Jonathan
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9155611/
https://www.ncbi.nlm.nih.gov/pubmed/35355067
http://dx.doi.org/10.1093/jac/dkac101
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author Luxton, Timothy
King, Natalie
Wälti, Christoph
Jeuken, Lars
Sandoe, Jonathan
author_facet Luxton, Timothy
King, Natalie
Wälti, Christoph
Jeuken, Lars
Sandoe, Jonathan
author_sort Luxton, Timothy
collection PubMed
description BACKGROUND: Dosing regimens guided by therapeutic drug monitoring (TDM) may be able to improve penicillin exposure in patients, which could result in improved patient health outcomes. OBJECTIVES: This systematic review aims to describe the impact penicillin TDM has on health outcomes, including antimicrobial resistance (AMR). METHODS: Studies measuring penicillins in patient samples that adjusted regimens according to the result, and reported health outcomes were selected. Study bias was assessed according to study type. Included study characteristics were tabulated and described by narrative synthesis. RESULTS: Three randomized controlled trials (RCTs), 16 cohort studies, and 9 case studies were included. No RCTs showed statistically significant improvements in health outcomes. Five cohort studies showed improvement in at least one health outcome associated with target attainment. However, there was a high risk of bias in all studies for health outcomes. One study assessed the impact of penicillin TDM on AMR and found that improved target attainment was associated with suppression of resistance. No studies found a detrimental effect of penicillin TDM. CONCLUSIONS: There is little evidence to suggest that TDM improves health outcomes, however neither health outcomes nor impact on AMR were adequately addressed. Variations in TDM implementation meant that a meta-analysis was not suitable. Penicillin TDM needs standardization, however there is currently no clear evidence of optimal conditions. Suitably powered studies are required to resolve the ambiguity surrounding the impact of TDM on clinical outcomes, including AMR. Further, standardized protocols and concentration targets need to be identified for TDM to be implemented successfully.
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spelling pubmed-91556112022-06-04 A systematic review of the effect of therapeutic drug monitoring on patient health outcomes during treatment with penicillins Luxton, Timothy King, Natalie Wälti, Christoph Jeuken, Lars Sandoe, Jonathan J Antimicrob Chemother Systematic Review BACKGROUND: Dosing regimens guided by therapeutic drug monitoring (TDM) may be able to improve penicillin exposure in patients, which could result in improved patient health outcomes. OBJECTIVES: This systematic review aims to describe the impact penicillin TDM has on health outcomes, including antimicrobial resistance (AMR). METHODS: Studies measuring penicillins in patient samples that adjusted regimens according to the result, and reported health outcomes were selected. Study bias was assessed according to study type. Included study characteristics were tabulated and described by narrative synthesis. RESULTS: Three randomized controlled trials (RCTs), 16 cohort studies, and 9 case studies were included. No RCTs showed statistically significant improvements in health outcomes. Five cohort studies showed improvement in at least one health outcome associated with target attainment. However, there was a high risk of bias in all studies for health outcomes. One study assessed the impact of penicillin TDM on AMR and found that improved target attainment was associated with suppression of resistance. No studies found a detrimental effect of penicillin TDM. CONCLUSIONS: There is little evidence to suggest that TDM improves health outcomes, however neither health outcomes nor impact on AMR were adequately addressed. Variations in TDM implementation meant that a meta-analysis was not suitable. Penicillin TDM needs standardization, however there is currently no clear evidence of optimal conditions. Suitably powered studies are required to resolve the ambiguity surrounding the impact of TDM on clinical outcomes, including AMR. Further, standardized protocols and concentration targets need to be identified for TDM to be implemented successfully. Oxford University Press 2022-03-31 /pmc/articles/PMC9155611/ /pubmed/35355067 http://dx.doi.org/10.1093/jac/dkac101 Text en © The Author(s) 2022. Published by Oxford University Press on behalf of British Society for Antimicrobial Chemotherapy. https://creativecommons.org/licenses/by/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Systematic Review
Luxton, Timothy
King, Natalie
Wälti, Christoph
Jeuken, Lars
Sandoe, Jonathan
A systematic review of the effect of therapeutic drug monitoring on patient health outcomes during treatment with penicillins
title A systematic review of the effect of therapeutic drug monitoring on patient health outcomes during treatment with penicillins
title_full A systematic review of the effect of therapeutic drug monitoring on patient health outcomes during treatment with penicillins
title_fullStr A systematic review of the effect of therapeutic drug monitoring on patient health outcomes during treatment with penicillins
title_full_unstemmed A systematic review of the effect of therapeutic drug monitoring on patient health outcomes during treatment with penicillins
title_short A systematic review of the effect of therapeutic drug monitoring on patient health outcomes during treatment with penicillins
title_sort systematic review of the effect of therapeutic drug monitoring on patient health outcomes during treatment with penicillins
topic Systematic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9155611/
https://www.ncbi.nlm.nih.gov/pubmed/35355067
http://dx.doi.org/10.1093/jac/dkac101
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