Therapeutic Monitoring

Monitor for therapeutic response by assessing efficacy and toxicity of the antimicrobial regimen.

• Clinical presentation/physical findings

• Efficacy: Assess vital signs (monitor for return to normal or lack of altered findings; e.g., fever), physical examination findings, patient's subjective impression

• Toxicity: Monitor and assess for adverse effects and evaluate antimicrobial serum concentrations when appropriate to minimize toxicity and improve outcomes

• Diagnostic imaging: Diagnostic testing is disease state-dependent

• Laboratory data

• Monitor and assess laboratory data: WBC with differential (goal is a reduction in WBC if elevated initially and resolution of left shift), renal and/or hepatic function (consider need for dosage adjustments), other labs as indicated (e.g., ESR, CRP)

• Follow-up on culture and susceptibility reports with subsequent de-escalation of therapy, if possible

• Reculture of specimens is not performed routinely except in few cases (e.g., endocarditis) or where a secondary infection is suspected because data may be misleading and lead to the addition of broader or more powerful antimicrobials

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