Therapeutic Drug Monitoring of Anti-infective Drugs: Implementation Strategies for 3 Different Scenarios.
Therapeutic Drug Monitoring of Anti-infective Drugs: Implementation Strategies for 3 Different Scenarios.
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DOI：
10.1097/ftd.0000000000000936
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发表时间：
2022-02-01
影响因子：
2.5
通讯作者：
Alffenaar JC
中科院分区：
文献类型：
--
作者：
Kim HY;Byashalira KC;Heysell SK;Märtson AG;Mpagama SG;Rao P;Sturkenboom MGG;Alffenaar JC
治疗药物监测（TDM）支持个性化治疗。为了成功实施，TDM必须有一个适合患者及其医疗机构临床需求的周转时间。在这里，作者分享了他们对如何根据特定环境和患者群体定制TDM策略的看法。作者为TDM选择了不同的场景：高风险、复杂和/或危重患者人群;门诊患者;实验室资源有限的环境。除了TDM情景方法外，他们还探讨了管理剂量递增的法律的框架的潜在问题。在不同的情况下确定的最重要的问题是，重症患者需要快速的周转时间，门诊患者需要一个简单的采样程序，相对于样本基质以及样本采集时间，设置有限的实验室资源需要设置特定的分析技术，所有的情况下都需要一个法律的框架，以捕捉使用递增的剂量，理想情况下使用可跟踪的剂量软件。为了使患者受益，TDM策略需要针对目标人群进行调整。可以调整策略，以确保重症患者的快速周转时间、门诊患者的方便采样以及实验室资源有限的情况下的可行性。
Therapeutic drug monitoring (TDM) supports personalized treatment. For successful implementation, TDM must have a turnaround time suited to the clinical needs of patients and their health care settings. Here, the authors share their views of how a TDM strategy can be tailored to specific settings and patient groups. The authors selected distinct scenarios for TDM: high-risk, complex, and/or critically ill patient population; outpatients; and settings with limited laboratory resources. In addition to the TDM scenario approach, they explored potential issues with the legal framework governing dose escalation. The most important issues identified in the different scenarios are that critically ill patients require rapid turnaround time, outpatients require an easy sampling procedure with respect to the sample matrix as well as sample collection times, settings with limited laboratory resources necessitate setting-specific analytical techniques, and all scenarios warrant a legal framework to capture the use of escalated dosages, ideally with the use of trackable dosing software. To benefit patients, TDM strategies need to be tailored to the intended population. Strategies can be adapted for rapid turnaround time for critically ill patients, convenient sampling for outpatients, and feasibility for those in settings with limited laboratory resources.