Diagnostic and Clinical Needs for Therapeutic Drug Monitoring of Antimicrobials

Sepsis remains a significant cause of morbidity and mortality worldwide due to antimicrobial resistance and limited new antibiotics, especially in patients with gram-negative bacteria (GNB) infections. Repurposing old antibiotics is necessary, but dosing often fails to achieve effective concentrations due to haemodynamic changes in septic patients. The “one size fits all” dosing principle for difficult-to-treat GNB infections is no longer viable. Therapeutic drug monitoring (TDM) becomes crucial in ensuring adequate dosing and combatting treatment failure, resistance emergence and antibiotic toxicity in septic patients. Mechanisms for optimising antibiotic concentrations within individual patients are under development. However, several barriers remain in realising true individualisation of therapy. We will examine the current state of antimicrobial TDM, emphasising the local context.