Role of Therapeutic Drug Monitoring of Beta-lactam Antibiotics in Special Populations

Objective To synthesize the current literature regarding the role of therapeutic drug monitoring (TDM) of beta-lactam antibiotics in special populations. The review aims to highlight pharmacokinetic (PK) variability across these cohorts and evaluate clinical evidence supporting the use of TDM to optimize treatment outcomes in patients with high PK variability, including those who are obese, pregnant, pediatric, geriatric, or critically ill, as well as those with renal or hepatic impairment. Methods A targeted, non-systematic literature search was conducted for English-language articles published since 2000 using PubMed/MEDLINE and Google Scholar. Keywords focused on TDM, beta-lactams (e.g., piperacillin, meropenem), and special populations. Included articles directly addressed the implementation, utility, or clinical outcomes of TDM for beta-lactam antibiotics in the defined special patient populations. Results Beta-lactam efficacy is best predicted by the duration of the dosing interval during which free drug concentrations remain above the minimum inhibitory concentration (fT>MIC). Special populations experience pathophysiological changes that alter PK parameters like volume of distribution and clearance, increasing the risk of therapeutic failure. For instance, obese critically ill patients often exhibit a higher volume of distribution and may require higher doses or prolonged/continuous infusions to achieve targeted pharmacodynamic exposure. Adjusting the dose and dosing interval based on renal function or continuous renal replacement therapy is also crucial for maintaining optimal peak concentrations and avoiding toxicity. Conclusion Implementing TDM and setting predefined PK/PD targets can minimize the risk of therapeutic failure and improve clinical outcomes in special populations. Individualizing dosage regimens through routine TDM maximizes therapeutic effectiveness while minimizing toxicity and the development of antimicrobial resistance.