Imagine developing a serious infection and making an appointment to see your healthcare provider. They prescribe an antibiotic, and you follow the treatment regimen perfectly, yet the infection persists. You wouldn’t be alone in reacting with confusion, frustration or even fear, yet this situation is more common than one may think. In fact, it’s a reality that drives a wide range of activities taking place inside the University of Florida College of Pharmacy’s Infectious Disease Pharmacokinetics Laboratory, or IDPL.
The IDPL helps clinicians care for patients with infections such as tuberculosis, HIV and fungal infections by providing therapeutic drug monitoring, or TDM. When a clinician orders TDM, the patient has blood drawn at specific times after receiving an antibiotic. The samples are then sent to the IDPL, where medical technologists measure how much antibiotic is in the blood and the results are interpreted by pharmacists.
The measurements provide clinicians with a clearer picture of how a patient’s body is absorbing, distributing, metabolizing and eliminating the medication. The results can help manage drug interactions and determine whether the patient’s dose should be adjusted.
Led for the last 38 years by Charles Peloquin, Pharm.D., the Jack C. Massey Endowed Professor and past associate chair of the Department of Pharmacotherapy and Translational Research in the UF College of Pharmacy, the IDPL will soon see new leadership under the direction of Nicole Maranchick, Pharm.D., a clinical assistant professor of pharmacotherapy and translational research.
Maranchick said the IDPL’s methods not only optimize a patient’s antibiotic regimen but ensure the continuing efficacy of antibiotics for future patients.
“By helping patients receive the right dose at the right time, antimicrobial TDM supports more precise, individualized care and may also contribute to antimicrobial stewardship efforts by reducing the risk of treatment failure and the emergence of antibiotic resistance,” Maranchick said. “Too much of a medication, and the patient can be at risk for drug toxicities. Too little of a medication, and they are at risk for the antibiotics not curing the infection. Additionally, not having enough drug available can increase the risk of antibiotic resistance. Personalized TDM consultations can reduce the need for trial-and-error dose adjustments, allowing clinicians to optimize therapy earlier during treatment. The results may include faster infection control, shorter hospital stays and more appropriate antibiotic use overall.”
Determining the right drug concentration — especially for a patient at greater risk due to factors like kidney function, age, body size, severe illness or other medical conditions — can prevent serious complications and even death, particularly with antibiotics that have a narrow margin between effective and potentially harmful concentrations. In addition to this core service and the IDPL’s extensive catalog of assays, or tests that measure the concentrations of antimicrobials like antibiotics, Maranchick said she is most proud of the information and support the lab provides clinicians.
“What really sets us apart is that we will interpret the results for the clinicians. Most labs will send the results back to the ordering clinicians without interpretation, but we will also provide comments about what the results mean and provide dose recommendations,” she said. “We’re also available to provide consultations with clinicians on the patients they are treating.”
As Maranchick looks to the IDPL’s future under her leadership, she has set her sights on growing the lab’s capacity to assay drugs that have recently entered the market. She credits Peloquin’s insightful guidance as motivation, inspiring her and her colleagues into a new era of continued excellence.
“Expanding the drug catalog is a component of the lab’s future direction,” Maranchick said. “Several new antibiotics have come to market and are increasingly being used, both at our institution and across the country, creating opportunities to expand our menu.”
Clinicians interested in using the IDPL for testing should contact the lab at idpl@cop.ufl.edu or visit idpl.pharmacy.ufl.edu.