Guideline Video

Guideline Resources

  • Beta-Lactam Antibiotic Dose Individualization in Acutely Ill Patients 
  • American College of Clinical Pharmacy
  • July 22, 2026
  • Summary
  • Full-text

Video Transcription

Just published July 22nd, 2026, the American College of Clinical Pharmacy’s newest consensus guidance on Beta-Lactam Antibiotic Dose Individualization in Acutely Ill Patients.

This consensus will equip healthcare professionals caring for acutely ill patients treated with beta-lactam therapy with the evidence and tools necessary to guide optimal use of beta-lactam dose individualization.

In today’s rapid update, we’ll just be going over a summary of recommendations and best practice statements so for the full guidance, make sure to check it out on guidelinecentral.com

Let’s get started. 

  • The panel suggests the use of beta-lactam antibiotic dose individualization to improve patient-centered treatment outcomes.
  • The panel suggests beta-lactam dose individualization programs pursue a minimum pharmacokinetic/pharmacodynamic (PK/PD) target of 100% fT>minimum inhibitory concentration (MIC) to improve the likelihood of clinical cure. The panel cannot recommend for or against specific targets for mortality, microbiologic cure, or length of stay.
  • The panel recognizes the importance of loading doses and/or prolonged infusions to achieve a minimum PK/PD target of at least 100% fT>MIC with beta-lactam dose individualization. In infections at sites with decreased drug distribution, a higher plasma PK/PD target such as 100% fT>4×MIC may be appropriate to ensure adequate drug concentrations at the target site. 
  • The panel cannot make a recommendation on the role for beta-lactam dose individualization to improve safety outcomes.
  • Monitor for adverse events, particularly neurotoxicity, when beta-lactam dose individualization is performed. 
  • The panel cannot make a recommendation on a specific PK target for beta-lactam dose individualization to improve safety. 
  • It is the opinion of the panel that patients with acute or chronic kidney dysfunction, elderly patients, those expected to be on prolonged courses of therapy or at the extremes of body weight, and those at risk for drug accumulation, particularly when treated with beta-lactams such as cefepime, benefit from close monitoring of beta-lactam PK to prevent accumulation and mitigate toxicity risk. 
  • The panel supports the use of beta-lactam dose individualization in patients with critical illness, use of extracorporeal devices including extracorporeal membrane oxygenation, kidney replacement therapy, plasmapheresis, and blood purification/adsorptive systems and/or in patients with kidney dysfunction or augmented renal clearance. Beta-lactam dose individualization may be considered in other patient populations and treatment scenarios even when there is less evidence. 
  • Successful development and implementation of a beta-lactam dose individualization program requires a team of multidisciplinary stakeholders. The panel supports an implementation team with representation from institutional leadership, healthcare professionals, operational partners, regulatory support, and patients or their representatives. Stakeholder engagement is essential throughout program development and implementation, but involvement of specific individuals or groups at any given step of the process is guided by institution-specific need. 
  • The optimal method for integration of beta-lactam dose individualization into the clinical workflow depends on clinical practice structure and available resources. The panel supports patterning beta-lactam dose individualization workflows after those of other antibiotics such as vancomycin. After designing and implementing a beta-lactam dose individualization program into the clinical workflow, the panel supports iterative program evaluation at regular intervals. 
  • The panel supports the use of plasma or serum as the preferred specimen type for beta-lactam dose individualization. 
  • Clinical laboratories should follow established best practices and use a standard operating procedure for assay development, validation, calibration, and reporting. The panel suggests creation of a reporting plan and process including establishing interpretive criteria for values within, above, or below the typical range to support clinical decision making. 
  • The panel supports the use of proactive MIPD with beta-lactam concentrations over traditional TDM, the latter of which is reactive. The panel recognizes that either approach is preferred to dosing without the guidance of individual concentration data and that access to MIPD is limited. The ideal population PK model for use in MIPD would be developed and validated in the patient population in which it will eventually be applied. If not possible, MIPD model selection should be guided by other factors including study population, sample size, covariates, sample density and validation methods. 
  • In MIPD, the panel supports the use of a systematic approach to investigate discordances between observed concentrations and model-predicted concentrations before dosing changes are made. The assessment should include model appropriateness, accuracy of inputs, and stability of patient physiology/clinical status. 
  • The panel supports the use of a laboratory-defined MIC for beta-lactam dose individualization. If the reported MIC is within the susceptible range, the panel recommends the use of the susceptibility breakpoint or the epidemiologic cutoff value to guide beta-lactam dose individualization, rather than the isolate's reported MIC. When the isolate's MIC exceeds the susceptibility breakpoint or ECV/ECOFF, effectiveness and safety of other available antibiotics or antibiotic combinations should be considered. If no other safe antibiotic exists to which the organism tests susceptible, consideration could be given to use of one doubling dilution above the isolate MIC for beta-lactam dose individualization, provided the doses used to reach this threshold are safe in humans. 
  • Where free beta-lactam concentrations are available and validated, these are preferred. The panel notes free beta-lactam concentration assays are more technically complex, expensive, and not widely available. When measurement of free beta-lactam concentrations is unavailable, the panel supports estimating free concentrations from total concentrations using published protein binding values from the literature. 

And there you have it. Make sure to check out the full consensus guidance from the American College of Clinical Pharmacy and other related clinical decision support tools at guidelinecentral.com.

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