An Exploratory Clinical Study to assess the role of Therapeutic Drug Monitoring of Amikacin and Vancomycin in achieving target drug levels and reducing Adverse Drug Events in Hospitalised Patients

Therapeutic drug monitoring TDM plays a crucial role in drugs with narrow therapeutic indices such as aminoglycosides amikacin and glycopeptides vancomycin where small dosing changes can significantly impact efficacy or toxicity Both amikacin and vancomycin are critical narrow spectrum antibiotics frequently used in the treatment of severe infections particularly in critically ill patients However these drugs possess a narrow therapeutic index meaning that the range between an effective and a toxic dose is small For amikacin subtherapeutic dosing risks treatment failure and fosters the development of resistant Gram negative organisms while overdosing significantly increases the likelihood of nephrotoxicity and ototoxicity particularly in patients with renal dysfunction or prolonged therapy durations Similarly vancomycin underdosing may lead to persistent bacteraemia and resistance especially in Staphylococcus aureus infections while overdosing is associated with acute kidney injury AKI This is particularly problematic in the ICU where altered pharmacokinetics due to sepsis fluid shifts and organ dysfunction amplify inter individual variability As such precise dosing guided by Therapeutic Drug Monitoring TDM is essential to ensure efficacy while minimizing toxicity Hence we are planning to do TDM in critically ill patients as these patients often have altered and unpredictable pharmacokinetics due to changes in volume of distribution organ dysfunction and use of extracorporeal support Also TDM allows individualized dosing based on measured drug concentrations reducing the risk of toxicity and increasing the probability of target attainment This study outlines evidence based strategies for the implementation of TDM to maximize therapeutic efficacy while minimizing adverse effects