The Role of Therapeutic Drug Monitoring (TDM) by Clinical Pharmacists in Patients Undergoing Antibiotic Therapy: A Narrative Review
Keywords:
Therapeutic Drug Monitoring, Clinical Pharmacist, Antibiotic Therapy, Pharmacokinetics, Antimicrobial Resistance, Patient Outcomes, Healthcare CostAbstract
Therapeutic Drug Monitoring (TDM) is a vital clinical practice aimed at optimizing the effectiveness and safety of antibiotic therapy. This narrative review explores the impact of pharmacist led TDM on antibiotic use by evaluating its clinical, microbiological, and economic outcomes. A comprehensive literature search was conducted across Scopus, PubMed, and Google Scholar databases targeting peer reviewed studies published between 2015 and 2025. Studies were selected based on predefined inclusion criteria, and findings were thematically analysed. The review highlights that pharmacist led TDM significantly improves pharmacokinetic/pharmacodynamic (PK/PD) target attainment, reduces antibiotic related adverse events, shortens hospital stays, and enhances overall therapeutic outcomes. Furthermore, TDM contributes to antimicrobial resistance mitigation by ensuring precise antibiotic exposure and supporting rational use decisions such as de-escalation and oral conversion. In addition, economic evaluations demonstrate that TDM can reduce total healthcare costs, especially in patients with severe infections. Despite these advantages, barriers to widespread implementation include limited infrastructure, insufficient clinical training, lack of integrated information systems, and weak institutional policies. These findings underscore the need for stronger interdisciplinary collaboration, investment in clinical training and digital health tools, and the inclusion of TDM in antimicrobial stewardship frameworks. As a strategic intervention, pharmacist directed TDM offers substantial promise in optimizing antibiotic use and addressing the growing threat of antimicrobial resistance.
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