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

Author:

Luxton Timothy1ORCID,King Natalie2,Wälti Christoph3,Jeuken Lars24,Sandoe Jonathan5ORCID

Affiliation:

1. School of Biomedical Sciences, University of Leeds , Leeds LS2 9JT, UK

2. Leeds Institute of Health Sciences, University of Leeds , Leeds LS2 9JT, UK

3. School of Electronic and Electrical Engineering, University of Leeds , Leeds LS2 9JT, UK

4. Leiden Institute of Chemistry, Leiden University , PO Box 9502, 2300 RA, Leiden, The Netherlands

5. School of Medicine, University of Leeds , Leeds LS2 9JT, UK

Abstract

Abstract 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.

Funder

University of Leeds

Medical Research Council

Publisher

Oxford University Press (OUP)

Subject

Infectious Diseases,Pharmacology (medical),Pharmacology,Microbiology (medical)

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