The critically ill patient is often characterized by unique pharmacokinetic findings because of the dynamic nature of their illness and the common presence of multiple organ system dysfunction. Pharmacokinetics in the ICU patient are affected by altered volumes of distribution, altered protein binding, changes in liver and renal blood flow, hypoxia, and cytokines. Once-daily administration of aminoglycosides has been an area of interest within the past few years. Once-daily administration appears to be at least as effective and no more toxic than traditional dosing regimens. The enthusiasm of therapeutic drug monitoring in vancomycin dosing has diminished recently because of a lack of correlation between serum concentration and efficacy or toxicity. Well-designed outcome studies addressing therapeutic drug monitoring of a wide variety of drugs are lacking. Evidence does suggest that therapeutic drug monitoring decreases toxicity, but evidence regarding efficacy is more difficult to locate. Several studies have shown therapeutic drug monitoring to be cost-effective. Further research is needed to evaluate the effects of therapeutic drug monitoring on clinical outcomes in ICU patients.
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