Vol.63 No.3 May 2015
Therapeutic drug monitoring questionnaire survey of glycopeptide agents in Japan
1)Department of Infection Control and Prevention, Hyogo College of Medicine, 1-1 Mukogawa-cho, Hyogo, Japan
2)Department of Pharmacy, Hyogo College of Medicine
Abstract
In 2012, the therapeutic drug monitoring (TDM) guidelines for antimicrobial drugs were prepared. In this study, we conducted a questionnaire survey to compare the clinical application of TDM and the TDM guidelines for vancomycin (VCM) and teicoplanin (TEIC). The subjects were pharmacists working for 419 hospitals throughout Japan. A questionnaire regarding the TDM for VCM and TEIC was sent to them. Concerning VCM, responses were collected from 345 hospitals (82.3%) and from 300 hospitals (71.6%) for TEIC. The TDM performance rates (81%-100%) for VCM and TEIC were 61.4 and 55.3%, respectively, and a high TDM performance rate was achieved in more than 50% of the hospitals. VCM showed a significantly higher TDM performance rate (p=0.011). For the timing of TDM after the initial administration of VCM and TEIC, blood was collected on Day 3 in 63.0% of the hospitals and on Day 4 in 50.3%, respectively, showing the highest percentages. The target trough level of VCM for skin and soft tissue infection was approximately 12.5 to 15 μg/mL in approximately 90% of the hospitals. That for severe infection such as infective endocarditis and hospital-acquired pneumonia was 15 to 20 μg/mL in approximately 80% of the hospitals. On the other hand, the target trough level of TEIC for skin and soft tissue infection was 15 to 30 μg/mL in approximately 75% of the hospitals. That for severe infection was 20 to 30 μg/mL in approximately 50% of the hospitals. Concerning the initial administration design (normal kidney function, body weight: 60 kg), VCM was administered at 15 to 20 mg/kg(or 1 g) twice a day, as recommended in the TDM guidelines, in 31.9% of the hospitals. Initial dosing was designed using simulation software in 53.8% of the hospitals, showing the highest percentage. On the other hand, the loading dose of TEIC was 400 mg twice daily for 2 days, as recommended in the TDM guidelines, in 38.0% of the hospitals, showing the highest percentage. However, high-dose loading administration (600 mg twice daily for 2 days or 800 mg twice daily for 1 to 2 days) was performed in some hospitals. The date of blood collection for initial blood level monitoring and the target level were consistent with the recommendations in the TDM guidelines, but issues such as dependence on simulation software and high-dose loading with TEIC should be resolved in the future.
Key word
therapeutic drug monitoring, vancomycin, teicoplanin, national survey
Received
November 12, 2014
Accepted
March 4, 2015
Jpn. J. Chemother. 63 (3): 357-364, 2015
