Evaluation Of Vancomycin Therapeutic Drug Monitoring in Intensive Care Units of a University Hospital

Year 2023, , 300 - 303, 31.08.2023

Nursel Surmelioglu , Merve Berber

https://doi.org/10.36516/jocass.1341016

Abstract

Introduction and aim: Therapeutic drug monitoring (TDM) of vancomycin aims to achieve an optimal response and minimize the risk of toxicity by keeping plasma levels within the therapeutic range. In this study, we aimed to evaluate the treatment and appropriateness of TDM in patients receiving vancomycin.
Method: For this purpose, patients who received vancomycin in the ICUs of a university hospital during 8-month period between January and August 2022 were retrospectively evaluated. Demographic data, presence of renal dysfunction, length of stay, duration of treatment, dose, concomitant medications, presence of extracorporeal method, TDM, sampling time (trough and peak level) were collected.
Results: Within the scope of the study, 213 prescriptions of 202 patients were evaluated and it was revealed that TDM was performed in 18 (8%). A total of 26 trough (n=12) and peak (n=14) level were obtained. Three (25%) of the trough and eight (57%) of the peak samples were taken at the wrong time. 50% of the trough and 64% of the peak level results were outside the reference range. TDM was not performed in 174 patients taking nephrotoxic drugs concomitantly with vancomycin. There were 84 patients who developed acute kidney injury during treatment. TDM was performed in 10 (15%) of 65 patients with pretreatment renal dysfunction.
Conclusion: In order to minimize the risk of nephrotoxicity and to get the appropriate response, it is recommended that physicians should have a conscious approach, clinical pharmacists should take an active role and hospital pharmacists should make arrangements in the orders of patients who do not have TDM.

Keywords

Vancomycin, TDM, intensive care unit, plasma level.

References

• 1.Demirkan K. Terapötik ilaç monitörizasyonu. Yoğun Bakım Dergisi, 2007; 7(3): 365-9.
• 2.Yılmaz D. Yoğun bakım ünitesinde dar terapötik aralıklı ilaçların kan düzeyi izlemi. Yüksek Lisans Tezi, Hacettepe Üniversitesi Sağlık Bilimleri Enstitüsü. Ankara. 2005.
• 3.Kim Y, Kim S, Park J, Lee H. Clinical Response and Hospital Costs of TDM for Vancomycin in Elderly Patients. Journal of personal¬ized medicine, 2022; 12:163. https://doi.org/10.3390/jpm12020163
• 4.Carland JE, Stocker SL, Baysari MT, et al. Are vancomycin dosing guidelines followed? A mixed methods study of vancomycin pre¬scribing practices. Brit Jnl Clinical Pharma. 2021; 1-9. https://doi.org/10.1111/bcp.14834
• 5.Iwamoto T, Kagawa Y, Kojima M. Clinical Efficacy of TDM in Pa¬tients Receiving Vancomycin. Pharmaceutical Society of Japan. 2003; 26(6): 876-9. https://doi.org/10.1248/bpb.26.876
• 6.Rybak MJ, Le J, Lodise TP, et al. Therapeutic monitoring of van¬comycin for serious methicillin-resistant staphylococcus aureus infections: a revised consensus guideline and review by the amer¬ican society of health-system pharmacists, the ınfectious diseases society of america, the pediatric ınfectious diseases society, and the society of ınfectious diseases pharmacists. Am J Health-Syst Pharm. 2020; 77: 835-64. https://doi.org/10.1093/ajhp/zxaa036
• 7.Zamoner W, Prado IRS, Balbi AL, et al. Vancomycin dosing, mon¬itoring and toxicity: critical review of the clinical practice. Clinical And Experimental Pharmacology And Physiology. 2019; 46: 292-301. https://doi.org/10.1111/1440-1681.13066
• 8.Dilworth TJ, Schulz LT, Rose WE. Vancomycin Advanced TDM: Exercise in Futility or Virtuous Endeavor to Improve Drug Efficacy and Safety? Clinical Infectious Diseases. 2021; 72(10): 675-81. https://doi.org/10.1093/cid/ciaa1354
• 9.Baggs J, Fridkin SK, Pollack LA, et al. Estimating national trends in inpatient antibiotic use among US hospitals from 2006 to 2012. JAMA Intern Med. 2016; 176: 1639-48. https://doi.org/10.1001/jamainternmed.2016.5651
• 10.Demirkan K, Sürmelioğlu N. Yoğun bakımda bireyselleştirilmiş ilaç tedavisi. 1. Baskı, Ankara: Akademisyen Kitabevi A.Ş, 2022. https://doi.org/10.37609/akya.2061
• 11. Ye ZK, Tang HL, Zhai SD. Benefits of TDM of Vancomycin: A Systematic Review and Meta-Analysis. Plos One. 2013;8(10). https://doi.org/10.1371/journal.pone.0077169
• 12.Walker R, Whittlesea C. Clinical Pharmacy and Therapeutics. 5th Ed., London; Churchill Livingstone Elsevier Ltd. 2012. 13.Kang J, Lee M. Overview of TDM. The Korean Journal Of Internal Medicine, 2009; 24(1). https://doi.org/10.3904/kjim.2009.24.1.1
• 14. Darko W, Medicis JJ, Smith A, et al. Mississippi mud no more: cost-effectiveness of pharmacokinetic dosage adjustment of van¬comycin to prevent nephrotoxicity. Pharmacotherapy, 2003; 23: 643-50. https://doi.org/10.1592/phco.23.5.643.32199
• 15.Fernandez de Gatta MD, Calvo MV, Hernandez JM, Caballero D, San Miguel JF, et al. Cost-effectiveness analysis of serum vancomy¬cin concentration monitoring in patients with hematologic malig¬nancies. Clin Pharmacol Ther. 1996; 60(3): 332-40. https://doi.org/10.1016/S0009-9236(96)90060-0
• 16.Rybak MJ, Lomaestro BM, Rotschafer JC, et al. Vancomycin ther¬apeutic guidelines: a summary of consensus recommendations from the ınfectious diseases society of america, the american soci¬ety of health-system pharmacists, and the society of ınfectious dis¬eases pharmacists. Clinical Infectious Diseases. 2009; 49: 325-7. https://doi.org/10.1086/600877