Therapeutic Drug Monitoring of Antiretroviral Drugs

HIV is the virus that causes acquired immunodeficiency syndrome (AIDS). Four classes of drugs are used today to treat people with AIDS including nucleoside reverse transcriptase inhibitors (NRTIs), such as zidovudine, non-NRTIs (NNRTIs), which include nevirapine, delavirdine, and efavirenz; and protease inhibitors (PIs), such as

Table 10

Therapeutic Drug Monitoring of Antibiotics

Table 10

Therapeutic Drug Monitoring of Antibiotics

Drug

Specimen Requirement

Therapeutic Rangeh

Cost"

Amikacin

Serum or plasma

<5 |g/mL (trough) 15-25 |xg/mL (peak)c

$$

Gentamicin

Serum or plasma

1-2 |g/mL (trough) 4-8 |g/mL (peak)c

$$

Tobramycin

Serum or plasma

1-2 |g/mL (trough) 4-8 | g/mL (peak)c

$$

Vancomycin

Serum or plasma

5-15 |g/mL (trough) 30-40 |g (peak)

$$

Cefazolin

Serum or plasma

60-120 |g (peak)

$$$

Ciprofloxacin

Serum or plasma

3-5 | g/mL (peak) 0.5-2 |g/mL (trough)

$$$

a $, < $75; $$, < $100; $$$, > $100; $$$$, > $150. The costs are based on published charge for these tests in our hospital laboratory and reference laboratories.

b Therapeutic ranges are suggested ranges based on ranges used in our hospital laboratory as well as published ranges in textbooks and test catalogues of reference laboratories. Reference ranges may vary significantly depending on patient population, disease states, and others.

c Based on traditional dosing of aminoglycosides. Extended intravenous dosing may produce higher peak values.

a $, < $75; $$, < $100; $$$, > $100; $$$$, > $150. The costs are based on published charge for these tests in our hospital laboratory and reference laboratories.

b Therapeutic ranges are suggested ranges based on ranges used in our hospital laboratory as well as published ranges in textbooks and test catalogues of reference laboratories. Reference ranges may vary significantly depending on patient population, disease states, and others.

c Based on traditional dosing of aminoglycosides. Extended intravenous dosing may produce higher peak values.

saquinavir, ritonavir, indinavir, nelfinavir, amprenavir, lopinavir, and atazanavir. Therapeutic drug monitoring of these drugs is discussed in Chapter 10. Suggested reference ranges and costs of monitoring antiretroviral drugs are given in Table 11.

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