The target therapeutic ranges of
vancomycin,
teicoplanin, and
arbekacin have been determined, and therapeutic drug monitoring (TDM) is performed in clinical practice. However, TDM is not obligatory for
daptomycin,
linezolid, or
tedizolid. In this study, we examined whether TDM will be necessary for these 3 drugs in the future. There was no significant difference in
therapeutic effects on acute bacterial skin and skin structure
infection between
linezolid and
tedizolid by meta-analysis. Concerning the
therapeutic effects on
pneumonia, the rate of effectiveness
after treatment with
tedizolid was significantly lower than with
linezolid. With respect to safety, the incidences of gastrointestinal adverse events and blood/lymphatic system disorders related to
tedizolid were significantly lower than those related to
linezolid.
Linezolid exhibits potent
therapeutic effects on
pneumonia, but the appearance of adverse reactions is indicated as a problem. There was a dose-dependent decrease in the platelet count, and the target trough concentration (Ctrough) was estimated to be 4-6 or 2-7 µg/mL in accordance with the patient's condition. The efficacy of
linezolid may be obtained while minimizing the appearance of adverse reactions by performing TDM. The target therapeutic range of
tedizolid cannot be achieved in immunocompromised or severe patients. Therefore, we concluded that TDM was unnecessary, considering step-down
therapy with oral drugs, use in non-severe patients, and high-level safety. Concerning
daptomycin, high-dose administration is necessary to achieve an area under the curve (AUC) of ≥666 as an index of efficacy. To secure its safety, Ctrough (<20 µg/mL) monitoring is important. Therefore, TDM is necessary.