scholarly journals Administration and Therapeutic Drug Monitoring of β-lactams and Vancomycin in Critical Care Units in Colombia: The ANTIBIOCOL Study

Pharmaceutics ◽  
2021 ◽  
Vol 13 (10) ◽  
pp. 1577
Author(s):  
Yuli V. Fuentes ◽  
Jhosep Blanco ◽  
Diana Marcela Díaz-Quijano ◽  
Sharon Lechtig-Wasserman ◽  
Hans Liebisch-Rey ◽  
...  
Keyword(s):  
Critical Care ◽  
Therapeutic Drug Monitoring ◽  
Drug Monitoring ◽  
Nationwide Survey ◽  
Bivariate Analysis ◽  
Therapeutic Drug ◽  
Critical Care Units ◽  
Effective Interventions ◽  
Extended Infusion

Therapeutic drug monitoring (TDM) and continuous infusion strategies are effective interventions in clinical practice, but these practices are still largely unknown in Colombia, especially in the critical care setting. This study aims to describe the practices involved in the administration and TDM of β-lactams and vancomycin reported by specialists in critical care in Colombia and to explore the factors that are related to the use of extended infusion. An online nationwide survey was applied to 153 specialists, who were selected randomly. A descriptive, bivariate analysis and a logistic regression model were undertaken. In total, 88.9% of the specialists reported TDM availability and 21.57% reported access to results within 6 h. TDM was available mainly for vancomycin. We found that 85.62% of the intensivists had some type of institutional protocol; however, only 39.22% had a complete and socialized protocol. The odds of preferring extended infusions among those who did not have institutional protocols were 80% lower than those with complete protocols, OR 0.2 (95% CI: 0.06−0.61). The most important perceived barriers to performing continuous infusions and TDM were the lack of training and technologies. This pioneering study in Colombia could impact the quality of care and outcomes of critically ill patients in relation to the threat of antimicrobial resistance.

Neural and Kernal Methods for Therapeutic Drug Monitoring

2011 ◽  
pp. 238-261 ◽  
Author(s):  
G. Camps-Valls ◽  
J. D. Martin-Guerrero
Keyword(s):  
Therapeutic Drug Monitoring ◽  
Drug Monitoring ◽  
Substantial Improvement ◽  
Physical Models ◽  
Therapeutic Drug ◽  
Optimal Dosage ◽  
Blood Concentrations ◽  
Clinical Problems

Recently, important advances in dosage formulations, therapeutic drug monitoring (TDM), and the emerging role of combined therapies have resulted in a substantial improvement in patients’ quality of life. Nevertheless, the increasing amounts of collected data and the non-linear nature of the underlying pharmacokinetic processes justify the development of mathematical models capable of predicting concentrations of a given administered drug and then adjusting the optimal dosage. Physical models of drug absorption and distribution and Bayesian forecasting have been used to predict blood concentrations, but their performance is not optimal and has given rise to the appearance of neural and kernel methods that could improve it. In this chapter, we present a complete review of neural and kernel models for TDM. All presented methods are theoretically motivated, and illustrative examples in real clinical problems are included.

Is Therapeutic Drug Monitoring for Anti-tumour Necrosis Factor Agents in Adults With Inflammatory Bowel Disease Ready for Standard of Care? A Systematic Review and Meta-analysis

2020 ◽  
Vol 14 (8) ◽  
pp. 1057-1065 ◽  
Author(s):  
Raj Shah ◽  
Gila R Hoffman ◽  
Mohammed El-Dallal ◽  
Alexander M Goldowsky ◽  
Ye Chen ◽  
...  
Keyword(s):  
Systematic Review ◽  
Inflammatory Bowel Disease ◽  
Therapeutic Drug Monitoring ◽  
Bowel Disease ◽  
Drug Monitoring ◽  
Meta Analysis ◽  
Therapeutic Drug ◽  
Quality Of Evidence ◽  
Inflammatory Bowel

Abstract Introduction Using therapeutic drug monitoring [TDM] in adult patients with inflammatory bowel disease [IBD] remains controversial. We conducted a systematic review and meta-analysis to answer four clinical PICO [Population, Intervention, Comparator, Outcome] questions. Methods We searched MEDLINE, Embase, Web of Science, and Cochrane Central from inception to June 30, 2019. Remission was defined by the manuscripts’ definitions of clinical remission. Data were analysed using RevMan 5.3. Quality of evidence was assessed with GRADE methodology. Results We identified and screened 3365 abstracts and 11 articles. PICO 1 Reactive vs No TDM: six studies pooled showed 57.1% [257/450] failed to achieve remission following reactive TDM vs 44.7% [268/600] in the no TDM group (risk ratio [RR]: 1.14; 95% confidence interval [CI] 0.88–1.47). PICO 2 Proactive vs no TDM: five studies pooled showed 19.5% [75/384] failed to maintain remission in the proactive TDM group vs 33.4% [248/742] in the no TDM group [RR: 0.60; 95% CI 0.35–1.04]. PICO 3 Proactive vs Reactive TDM: two retrospective studies pooled showed 14.2% [26/183] failure to maintain remission in the proactive TDM group and 64.7% [119/184] in the reactive TDM group [RR: 0.22; 95% CI 0.15–0.32]. PICO 4 TDM [proactive/reactive] vs No TDM: we pooled 10 studies showing 39.7% [332/837] failed to achieve remission in the TDM [proactive/reactive] cohort vs 40.3% [428/1063] in the no TDM cohort [RR: 0.94; 95% CI 0.77–1.14]. Overall, the quality of evidence in each PICO was very low when using GRADE. Conclusions This meta-analysis shows that data supporting use of TDM in adults are limited and of very low quality. Further well-designed randomized controlled trials are needed to determine the place of TDM in clinical practice.

scholarly journals Exploring the role of therapeutic drug monitoring and regular supervision in optimizing quality of life in patients of bipolar affective disorder receiving lithium therapy in a tertiary care teaching hospital: a prospective observational study

2020 ◽  
Vol 8 (8) ◽  
pp. 2813
Author(s):  
Santanu Munshi ◽  
Agnik Pal
Keyword(s):  
Quality Of Life ◽  
Therapeutic Drug Monitoring ◽  
Drug Monitoring ◽  
Lithium Therapy ◽  
Therapeutic Drug ◽  
Health Related Quality ◽  
Related Quality ◽  
Health Related ◽  
Bipolar Affective Disorders

Background: Lithium is considered first line drug effective in treating manic and mixed episodes of bipolar affective disorders throughout the globe. But the chronic and heterogenous nature of disease, along with toxicity of lithium often make patients non-adherent to medication as well as diminished health related quality of life. Present study was done to find out the prospect of regular supervision and follow up with therapeutic drug monitoring in optimization of lithium therapy based on health-related quality of life outcomes.Methods: It was a prospective, non-randomized, observational study of a cohort of subjects who are suffering from bipolar affective disorders and on lithium therapy. Patients were regularly followed up with therapeutic drug monitoring and personalized interview with questionnaires like WHO Quality of Life Score (QOL-Bref), Montgomery-Asberg Depression Scale (MADRS) and Medication Adherence Rating Scale (MARS).Results: Results revealed there was significant improvement in health-related quality of life of patients who were monitored with therapeutic drug monitoring and prescribed lithium therapy.Conclusions: Hence to maintain patients’ quality of life improved throughout the cycle of bipolar disorder spectrum, regular follow-up visits with monitoring of serum levels of lithium is needed, so that adverse effects would be minimal and adherence to medication become optimal. These optimal dosing resulting in optimal benefit to patients can be achieved with the involvement of clinical pharmacological consultation.

Strategies for physician education in therapeutic drug monitoring

1998 ◽  
Vol 44 (2) ◽  
pp. 401-407 ◽  
Author(s):  
David W Bates ◽  
Steven J Soldin ◽  
Petrie M Rainey ◽  
Joseph N Micelli
Keyword(s):  
Quality Improvement ◽  
Therapeutic Drug Monitoring ◽  
Drug Monitoring ◽  
Physician Education ◽  
Therapeutic Drug ◽  
Inpatient Setting ◽  
Drug Concentrations ◽  
And Behavior ◽  
Traditional Approaches

Abstract Although therapeutic drug monitoring (TDM) is probably very useful overall, studies suggest that it could be used better. Many drug concentrations appear to have inappropriate indications or suboptimal timing, particularly in the inpatient setting. Undermonitoring is also a concern. Thus, it may be possible to both improve the quality of TDM and reduce the overall costs of care. Here we review approaches for improving the use of TDM and present some illustrative experiences. Specific approaches discussed include use of traditional approaches such as lectures and newsletters, multidisciplinary quality improvement efforts, formal TDM services, and use of the computer as a tool for education and behavior change. Computerized methods appear to hold substantial potential, particularly as more organizations develop better information systems, but other approaches are also effective and are complementary. To be most successful, interventions should consider all stages of the process.

Comparison of two empirical prolonged infusion dosing regimens for meropenem in patients with septic shock: A pilot two-center study

2020 ◽  
Author(s):  
Albrecht Eisert ◽  
Christian Lanckohr ◽  
Janina Frey ◽  
Otto Frey ◽  
Sebastian G. Wicha ◽  
...  
Keyword(s):  
Therapeutic Drug Monitoring ◽  
Drug Monitoring ◽  
Severe Disease ◽  
Therapeutic Drug ◽  
Prolonged Infusion ◽  
Minimal Inhibitory Concentrations ◽  
Drug Concentrations ◽  
Dosing Regimens ◽  
Higher Doses ◽  
Extended Infusion

Abstract Background : Sepsis is a severe disease with complex pathophysiology and high mortality. Meropenem is frequently used in sepsis to treat the underlying infection. Studies have shown that standard doses of meropenem are frequently inadequate due to high pharmacokinetic and pharmacodynamic variability. Therapeutic drug monitoring (TDM) of meropenem is not widely available, and increased empiric dosing recommendations are needed. Methods : We compared two empiric dosing schemes of meropenem using extended infusion (120 minutes) in 32 patients with sepsis in the ICUs at two different hospitals. One regimen was 3x 2 g meropenem/ 24 h for two days, followed by 3x 1 g meropenem/ 24 h; the other regimen was 4x 1 g meropenem/ 24 h. Serum meropenem concentrations were measured for the first 72 h of therapy, and pharmacokinetic modelling was performed to define the percentage of time the dosing interval was above various target minimal inhibitory concentrations (MICs) for each regimen (%fT >MIC ). Results : Both regimens led to a sufficiently high %fT >MIC for pathogens with target MICs below 4 mg/L. When higher MICs were targeted, the %fT >MIC of 4x 1 g meropenem decreased faster than that of 3x 2 g meropenem. At high MICs of 32 mg/L, both dosing regimens failed to provide drug concentrations deemed appropriate for clinical improvement. Conclusions : The results of this pilot study can guide clinicians in their choice of an empirical dosing scheme when prescribing meropenem in the absence of TDM. If pathogens with low MICs (<4 mg/L) are targeted, both dosing regimens are adequate, whereas more resistant clones require higher doses. The control of β-lactam therapy by therapeutic drug monitoring is desirable.

Mass spectrometry of blood low-molecular fraction as a method for unification of therapeutic drug monitoring

2014 ◽  
Vol 60 (2) ◽  
pp. 201-216 ◽  
Author(s):  
P.G. Lokhov ◽  
D.L. Maslov ◽  
O.P. Trifonova ◽  
E.E. Balashova ◽  
A.I. Archakov
Keyword(s):  
Drug Therapy ◽  
Therapeutic Drug Monitoring ◽  
Drug Monitoring ◽  
Therapeutic Drug ◽  
Ionization Source ◽  
Molecular Fraction ◽  
Primary Means ◽  
Drug Doses ◽  
Almost All

The article describes a new therapeutic drug monitoring (TDM) method based on direct infusion of low-molecular fraction of blood into electrospray ionization source of mass spectrometer. This technique allows performing TDM of almost all drugs used in clinic. In article, the universality and high-throughput of the method, that significantly simplifies its wide application, have been shown. Moreover, the possibility of method application in most cases of drug therapy has been argued as a tool of control of drug doses, rationality of drug therapy, and the quality of the drugs themselves. In conclusion, the prospects for application of the method as primary means of improving the quality and personalization of drug therapy have been discussed.

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