Therapeutic Drug Monitoring in Critical Care Settings
Summary
Therapeutic drug monitoring (TDM) in critical care has become integral to optimising antimicrobial and other drug therapies amid the profound physiological disturbances encountered in intensive care. Critical illness alters volume of distribution, protein binding and organ clearance, leading to unpredictable plasma concentrations and risking both therapeutic failure and toxicity. Personalised dosing strategies that incorporate real-time measurements, pharmacokinetic/pharmacodynamic (PK/PD) targets and model-informed precision dosing are being adopted to improve outcomes. Continuous and prolonged infusions of time-dependent antibiotics, adaptive dosing guided by population pharmacokinetic (popPK) models and Bayesian forecasting permit dose adjustments before steady state is achieved. These approaches aim to maintain drug exposures above defined PK/PD thresholds—such as maintaining free concentrations several-fold above the minimal inhibitory concentration (MIC) for a specified proportion of the dosing interval—while reducing adverse events in a heterogeneous patient population. Advances in assay technologies, automation of dose calculators and integration of electronic health records further enhance the feasibility of TDM in the dynamic critical care environment.
Research from Nature Portfolio
No recent Nature Portfolio content available.
Therapeutic Drug Monitoring in Critical Care Settings publication trend
The graph below shows the total number of articles in therapeutic drug monitoring in critical care settings across all publications each year (not limited to Nature Index journals).
Technical terms
Therapeutic Drug Monitoring (TDM): Measurement of drug concentrations in biological fluids to adjust dosing for individual patients.
Population Pharmacokinetic (popPK) Model: A mathematical framework describing drug concentration–time profiles in a target population, accounting for variability between individuals.
Minimal Inhibitory Concentration (MIC): The lowest antibiotic concentration that prevents visible growth of a microorganism in vitro.
Pharmacokinetic/Pharmacodynamic (PK/PD) Target: A quantitative relationship between drug exposure (pharmacokinetics) and drug effect (pharmacodynamics), such as the duration or extent of concentration above the MIC required for efficacy.
References
- The effect of pathophysiology on pharmacokinetics in the critically ill patient — Concepts appraised by the example of antimicrobial agents. Advanced Drug Delivery Reviews (2014).
- Bayesian prediction-based individualized dosing of anti-methicillin-resistant Staphylococcus aureus treatment: Recent advancements and prospects in therapeutic drug monitoring. Pharmacology & Therapeutics (2023).
- Optimization of the treatment with beta-lactam antibiotics in critically ill patients—guidelines from the French Society of Pharmacology and Therapeutics (Société Française de Pharmacologie et Thérapeutique—SFPT) and the French Society of Anaesthesia and Intensive Care Medicine (Société Française d’Anesthésie et Réanimation—SFAR). Critical Care (2019).
- The Minimum Inhibitory Concentration of Antibiotics: Methods, Interpretation, Clinical Relevance. Pathogens (2021).
About these summaries
This Nature Research Intelligence Topic summary is created with the cited references and a large language model. We take care to ground generated text with facts, and have systems in place to gain human feedback on the overall quality of the process in line with our AI principles. We strive to create accurate and useful summaries for people unfamiliar with the research topic and that supports this goal. These pages are a beta release and will be updated as we learn how best to help people gain value from a research topic summary.
Turn complex research questions into confident strategic decisions
When you're under pressure to set direction, justify investment, or understand your competitive position, you need more than raw data — you need trusted insights you can act on.
Benchmark your performance against global peers using robust, methodologically sound analysis.
Combine quantitative metrics with qualitative expert insight to uncover strengths, gaps and emerging opportunities.
Gain tailored, decision-ready recommendations aligned to your strategic priorities.
Talk to us to learn more about our data dashboards and bespoke strategy reports.
Grow research skills, confidence and careers with training built for every stage of the research lifecycle.
Developed with Nature Portfolio journal Editors and internationally renowned experts. Discover three ways to learn:
Self-paced, online courses in convenient bite-sized units, covering key skills across scientific writing, publishing, grant writing, data analysis, and more.
Expert trainer-led workshops with hands-on exercises and real-time feedback across core research skills, delivered via interactive group sessions.
Editor-led workshops combining core principles in writing and publishing, personalised 1:1 feedback from Nature Portfolio Editors and hands-on exercises.
Explore course catalogues and workshop agendas, enquire about the options or request institutional pricing.