ArticleTherapeutic drug monitoring2025
Utility of a TDM-Guided Expert Clinical Pharmacological Advice Program for Optimizing the Use of Novel Beta-Lactam/Beta-Lactamase Inhibitor Combinations and Cefiderocol in a Tertiary University Hospital: An Interim Analysis.
Article in Therapeutic drug monitoring, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.
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Who cites it
6 citing papers in PubMed.
- Role of Cefiderocol in the Treatment of Carbapenem-Resistant Nonfermenting Gram-Negative Bacilli (Acinetobacter baumannii, Pseudomonas aeruginosa, and Stenotrophomonas maltophilia) Infections: An Expert Statement.Infectious diseases and therapy · 2026Article
- Article
- Innovative Antibiotics: The Experience of Cefiderocol in Carbapenem-Resistant Gram-Negative Infections.Infection and drug resistance · 2026Review
- Sepsis in end-stage liver disease and acute-on-chronic liver failure: pathophysiology, diagnostic challenges, and pharmacological management.Frontiers in pharmacology · 2026Review
- Keeping the horse with the cart: are we underdosing tazobactam even when using continuous-infusion ceftolozane/tazobactam for effectively preventing resistance development by ESBL-producing Enterobacterales?Antimicrobial agents and chemotherapy · 2025Article
- TargetingAntimicrobial agents and chemotherapy · 2025Article
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Authors and funding
7 authors.
Funding
Abstract
backgroundThis study assessed the utility of a therapeutic drug monitoring (TDM)-guided expert clinical pharmacological advice (ECPA) program to optimize aggressive pharmacokinetic/pharmacodynamic (PK/PD) target attainment of novel beta-lactam/beta-lactamase inhibitor (BL/BLIc) combinations and cefiderocol.
methodsAll hospitalized patients who received TDM-guided ECPA with BL/BLIc (ceftazidime-avibactam, ceftolozane-tazobactam, or meropenem-vaborbactam) or cefiderocol were assessed retrospectively. Three performance indicators were identified: the average number of ECPAs delivered per month of availability of the program and the ratio between the total number of ECPAs recommending dosing adjustment and the total number of ECPAs, at the first and at subsequent TDM assessments. The relationships between aggressive PK/PD target attainment and clinical and microbiological outcomes were assessed.
resultsA total of 595 ECPAs were administered to 263 patients to optimize 319 treatment courses. Novel agents were mostly used for targeted therapy (79.6%) by continuous infusion (CI; 82.8%). In the first TDM assessment, dose increases were mostly required for patients receiving intermittent/extended infusion (II/EI) (51.9% vs. 6.4%; P < 0.0001), whereas dose decreases were mostly recommended for patients receiving CI (60.3% vs. 23.1%; P < 0.001). In subsequent TDM assessments, the overall proportion of ECPAs recommending dosing adjustments decreased in both groups (57.1% and 39.3% in the II/EI and CI groups, respectively). Aggressive PK/PD target attainment was associated with the highest microbiological eradication rate for ceftazidime-avibactam (79.6% out of 86.0%; P < 0.001), and the highest clinical cure rate for ceftazidime-avibactam (64.2% out of 78.1%; P < 0.001) and cefiderocol (50.0% out of 51.5%; P = 0.006).
conclusionsA dedicated TDM-guided ECPA program may be helpful for optimizing the use of novel agents in settings with a high prevalence of multidrug-resistant pathogens.
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