Vol.65 No.2 March 2017
National survey of therapeutic drug monitoring (TDM) of antimicrobial drugs
Division of Practical Pharmacy, Keio University Faculty of Pharmacy, 1-5-30 Shibakoen, Minato-ku, Tokyo, Japan
The therapeutic drug monitoring (TDM) guidelines for antimicrobial drugs were prepared in 2012. We carried out a fact-finding survey concerning the infection control systems and implementation of TDM of antimicrobial drugs at various institutions and compared the findings with the TDM guidelines for antimicrobial drugs.
Responses to our questionnaire survey were obtained from 391 institutions. TDM was implemented at 84% of the institutions, and it was implemented significantly more frequently at institutions that had been certified for additional payment for infection prevention measures, institutions with an ICT or AST, and institutions with Board Certified Pharmacists in Infection Control, Board Certified Infection Control Pharmacy Specialists, or Infectious Disease Chemotherapy Pharmacists. The target values of VCM and TEIC were set as recommended by the TDM guidelines for antimicrobial drugs at 95% of the institutions. Concerning ABK, AMK, GM, and TOB, the peak values were set as recommended at 88, 79, 82, and 85% of the institutions, and the trough values were set as recommended at 90, 75, 74, and 72% of the institutions, respectively. The total dose of TEIC on the first and second days was set at 1,600 mg at 59% of the institutions. The dose on once-a-day administration to patients with a normal kidney function was fixed at 200 mg for ABK at 46% of the institutions, 15 mg/kg for AMK at 74%, and 5 mg/kg at 50/55% and 5-7 mg/kg at 37/32%, respectively, for GM/TOB. On the planning of VCM administration, the AUC24 was not checked at 44% and checked each time at 27% of the institutions. The initial dose of VCM for dialysis patients was 1 g, 15-25 mg/kg, and 20-25 mg/kg at 31, 17, and 16%, respectively. The blood sampling point was before hemodialysis at 84%.
The results of this study suggest that the infection control system is correlated with the TDM implementation rate, and that an improvement in the percentage of certified pharmacists is important for the proper use of antimicrobial drugs. Many of the answers to the questionnaire were consistent with recommendations in the TDM guidelines for antimicrobial drugs, and the guidelines are considered to have sufficiently permeated to medical institutions. However, it is considered necessary to make the contents of the guidelines including the loading dose of TEIC, checking of the AUC on the planning of VCM administration, and the initial dose of VCM for dialysis patients better known.
TDM, guideline, glycopeptide, aminoglycoside
July 14, 2016
November 21, 2016
Jpn. J. Chemother. 65 (2): 175-182, 2017