Therapeutic drug monitoring (TDM) is a dosage individualization strategy that helps to minimize toxicity whilst maximizing the efficacy of an agent. For many years, beta-lactam antibiotics were not considered ideal candidates for TDM due to their wide therapeutic range. Profound and difficult to predict beta-lactam pharmacokinetic variability in specific patient populations and increasing bacterial resistance suggest that reaching optimal exposures can be challenging in some clinical settings. The aims are to review the role of beta-lactam TDM, identify patients that would most likely benefit from it, summarize methods used to measure beta-lactam concentrations and outline their limitations, discuss the concentration-effect relationship and therapeutic targets and finally describe dosage adjustment strategies.
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