Table 1.

Desired PK/PD target, thresholds for toxicity, and TDM-guided dosage adjustments of antimicrobials included in the expert clinical pharmacological advice (ECPA) program

Antimicrobial	Desired target	Threshold for toxicity	Dosage adjustment
Piperacillin–tazobactam	Css 4–8 × MIC (for piperacillin)	Cmin > 361 mg/L (neurotoxicity) [25]	Decrease 50% if Css > 10 × MIC 25% if Css 8–10 × MIC Increase 50% if Css < 2 × MIC 25% if Css 2–4 × MIC
Meropenem	Css 4–8 × MIC	Cmin > 64.2 mg/L (neurotoxicity) [25]	Decrease 50% if Css > 10 × MIC 25% if Css 8–10 × MIC Increase 50% if Css < 2 × MIC 25% if Css 2–4 × MIC
Ceftazidime	Css 4–8 × MIC	NA	Decrease 50% if Css > 10 × MIC 25% if Css 8–10 × MIC Increase 50% if Css < 2 × MIC 25% if Css 2–4 × MIC
Ampicillin Ampicillin–Sulbactam	Css 4–8 × MIC (for ampicillin)	NA	Decrease 50% if Css > 10 × MIC 25% if Css 8–10 × MIC Increase 50% if Css < 2 × MIC 25% if Css 2–4 × MIC
Cefepime	Css 4–8 × MIC	Cmin > 36 mg/L (neurotoxicity) [26]	Decrease 50% if Css > 10 × MIC 25% if Css 8–10 × MIC Increase 50% if Css < 2 × MIC 25% if Css 2–4 × MIC
Linezolid	Cmin 2–8 mg/L	Cmin > 8 mg/L (thrombocytopenia) [29, 30]	Decrease 50% if Cmin > 15 mg/L 25% if Cmin 8–15 mg/L Increase 50% if Cmin < 1 mg/L 25% if Cmin 1–2 mg/L
Levofloxacin	Cmax 10 × MIC Cmin < 3 mg/L	NA	Decrease every 36–48 h if Cmin > 2 mg/L Increase 25% if Cmax < 10 × MIC
Ciprofloxacin	Cmax 10 × MIC Cmin < 2 mg/L	NA	Decrease 25% if Cmin > 2 mg/L Increase 25% if Cmax < 10 × MIC
Fluconazole	Cmin 10–20 mg/L	NA	Decrease 50% if Cmin > 50 mg/L 25% if Cmin 30–50 mg/L Increase 25% if Cmin < 10 mg/L
Voriconazole	Cmin 1–3 mg/L	Cmin > 3–4 mg/L (hepatotoxicity) [28]	Decrease stop if Cmin > 8–10 mg/L 25–50% if Cmin 3.5–8 mg/L Increase every 6–8 h if Cmin < 1 mg/L
Posaconazole	Cmin 1–3 mg/L	Cmin > 3 mg/L (pseudohyperaldosteronism) [31]	Decrease 25–50% if Cmin > 3 mg/L Increase every 12 h if Cmin < 1 mg/L
Isavuconazole	Cmin 1–7 mg/L	Cmin > 5.1 mg/L (gastrointestinal disorders) [27]	Decrease 25–50% if Cmin > 5 mg/L Increase 25–50% if Cmin < 1 mg/L
Ganciclovir/Valganciclovir	Cmin 0.7–2 mg/L	NA	Decrease stop if Cmin > 5 mg/L 25–50% if Cmin 2–5 mg/L Increase every 6–8 h if Cmin < 0.5 mg/L
Acyclovir	Cmin 1–3 mg/L	NA	Decrease stop if Cmin > 5 mg/L 25–50% if Cmin 3–5 mg/L Increase every 6 h if Cmin < 0.5 mg/L

AUC area under concentration–time curve, C_max peak concentration, C_min trough concentration, C_ss steady-state concentration, CI continuous infusion, ECPA expert clinical pharmacology advice, MIC minimum inhibitory concentration, NA not available, TDM therapeutic drug monitoring