Appropriateness of vancomycin therapeutic drug monitoring and its outcomes among non-dialysis patients in a tertiary hospital in Singapore

Seng, Jun Jie Benjamin; Yong, Mei Hui Amanda; Peh, Zi Xin; Soong, Jie Lin; Tan, Mooi Heong

doi:10.1007/s11096-018-0670-4

Cited by 12 publications

(13 citation statements)

References 10 publications

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“…Bayesian estimation of the PK parameters can be performed with any timed plasma sample as long as the sampling time is accurately documented 48 . This makes MIPD attractive particularly for the clinical setting, as even for vancomycin, for which TDM is well established, 61.5% of trough samples are “wrongly” taken, requiring additional sampling, or causing delayed or wrong dose adjustment 60 . A study on tobramycin in cystic fibrosis patients demonstrated that AUC values determined using Bayesian forecasting can be more precise and less biased than the two‐point method if both samples are used, or as precise when only one single sample is used 61 .…”

Section: From Therapeutic Drug Monitoring To Model‐informed Precisionmentioning

confidence: 99%

“…48 This makes MIPD attractive particularly for the clinical setting, as even for vancomycin, for which TDM is well established, 61.5% of trough samples are "wrongly" taken, requiring additional sampling, or causing delayed or wrong dose adjustment. 60 A study on tobramycin in cystic fibrosis patients demonstrated that AUC values determined using Bayesian forecasting can be more precise and less biased than the two-point method if both samples are used, or as precise when only one single sample is used. 61 To determine the AUC in MIPD, using samples early after drug administration rather than the trough sample seems advantageous for aminoglycosides and vancomycin.…”

Section: Optimized Sampling Strategiesmentioning

confidence: 99%

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From Therapeutic Drug Monitoring to Model‐Informed Precision Dosing for Antibiotics

Wicha

Märtson

Nielsen

et al. 2021

Clin Pharma and Therapeutics

136

121

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(ISAP), the PK/PD study group of the European Society of Clinical Microbiology, Infectious Diseases (EPASG) Therapeutic drug monitoring (TDM) and model-informed precision dosing (MIPD) have evolved as important tools to inform rational dosing of antibiotics in individual patients with infections. In particular, critically ill patients display altered, highly variable pharmacokinetics and often suffer from infections caused by less susceptible bacteria. Consequently, TDM has been used to individualize dosing in this patient group for many years. More recently, there has been increasing research on the use of MIPD software to streamline the TDM process, which can increase the flexibility and precision of dose individualization but also requires adequate model validation and re-evaluation of existing workflows. In parallel, new minimally invasive and noninvasive technologies such as microneedle-based sensors are being developed, which-together with MIPD software-have the potential to revolutionize how patients are dosed with antibiotics. Nonetheless, carefully designed clinical trials to evaluate the benefit of TDM and MIPD approaches are still sparse, but are critically needed to justify the implementation of TDM and MIPD in clinical practice. The present review summarizes the clinical pharmacology of antibiotics, conventional TDM and MIPD approaches, and evidence of the value of TDM/MIPD for aminoglycosides, beta-lactams, glycopeptides, and linezolid, for which precision dosing approaches have been recommended.

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Section: From Therapeutic Drug Monitoring To Model‐informed Precisionmentioning

confidence: 99%

Section: Optimized Sampling Strategiesmentioning

confidence: 99%

From Therapeutic Drug Monitoring to Model‐Informed Precision Dosing for Antibiotics

Wicha

Märtson

Nielsen

et al. 2021

Clin Pharma and Therapeutics

136

121

View full text Add to dashboard Cite

show abstract

“…Ototoxicity is a less frequently described adverse effect of vancomycin and has not been as readily demonstrated, however vestibular damage and/or cochlear damage associated with tinnitus and sensorineural hearing loss has been reported in humans after administration of vancomycin [9–14]. The use of other ototoxic drugs known to cause sensorineural hearing loss, such as aminoglycosides or loop diuretics, concomitantly with vancomycin makes it difficult to prove a causal association [15].…”

Section: Introductionmentioning

confidence: 99%

Long-term vancomycin use had low risk of ototoxicity

Humphrey¹,

Veve²,

Walker³

et al. 2019

PLoS ONE

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BackgroundVancomycin is a commonly used antibiotic with potent activity against Gram-positive organisms, but prolonged use and high doses can lead to toxicity. While vancomycin-associated nephrotoxicity is widely reported, few cases of ototoxicity have been described. The objective of this study was to determine the prevalence of negative changes in audiograms in patients receiving long-term intravenous (IV) vancomycin and to identify high-risk patients who need audiogram monitoring.MethodsThis was an IRB approved, cross-sectional study performed at an academic medical center from 1/2012-3/2019. Patients who were prescribed IV vancomycin for ≥ 14 days and had baseline and follow-up weekly audiometry were included. All data was extracted from the electronic medical record. The primary endpoint was worsening audiogram while on vancomycin. Descriptive and bivariate statistics were used to describe the patient population.Results424 patients were screened for inclusion; 92 received at least two audiograms while on vancomycin. Fifty-three percent of patients were men, the median (IQR) patient age was 44 (34–58) years, and 8% of patients had an estimated Cockcroft-Gault creatinine clearance ≤ 30 mL/min or received hemodialysis. The median (IQR) vancomycin exposure up until the last recorded audiogram was 30 (17–42) days. Vancomycin indications were: 53 (58%) bone and joint infections, 17 (18%) infective endocarditis, 10 (11%) bacteremia, 12 (13%) other infections. Seven (8%) patients experienced a worsening change in hearing from baseline, two (2%) of them suffered mild loss, two (2%) had mild to moderate loss, and three (3%) developed moderate-to-severe hearing loss. In bivariate analyses, no variables were found to be associated with a worsening change in audiogram, including baseline abnormal audiogram, age ≥ 40 years, elevated serum vancomycin levels, or vancomycin doses ≥ 4 grams/day.ConclusionsThe prevalence of negative changes in audiograms among patients receiving long-term intravenous vancomycin was low. The utility of routine audiogram testing in this population remains questionable except in high-risk patients; however, larger prospective studies with controls may be warranted to further explore the risk of ototoxicity.

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“…It is also a tool to optimize the use of antibiotics 13. Several studies were conducted in this regard 11,14,15…”

Section: Introductionmentioning

confidence: 99%

Evaluation of aminoglycosides utilization in intensive care units of a teaching hospital in southern Iran

Vazin¹,

Mirjalili²,

Asadi³

2019

Pharm Pract (Granada)

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Background:Inappropriate use of antimicrobial agents is one of the most important factors in inducing resistance and prolonged hospitalization as well as increase in patient mortality rate.Objective:The aim of this study was to evaluate aminoglycosides (AGs) usage pattern at intensive care units (ICUs) of Nemazee hospital Shiraz, Iran.Methods:In this cross-sectional study, the usage pattern of AGs was evaluated during 32 months. Guidelines for AGs usage were approved by the drug and therapeutic committee of the hospital, and criteria were developed to assess 11 parameters involving AGs therapy, such as proper indication for the use of the drug, dosage and duration of therapy. Clinical parameters, such as microbial culture and sensitivity, serum creatinine (SCr) and creatinine clearance, and white blood cell count were evaluated.Results:Ninety-five patients were recruited, 50 male and 45 females. In most patients (64%) the origin of infection was hospital and only in 36% of them, community was the source. Ventilator associated pneumonia (27%), central nervous system (25%) and urinary tract infection (10%) were the most important indications for AGs prescription. Scores of AGs usage at Nemazee hospital was calculated as 5.9 out of 11, which meant that in only 54% of cases AGs prescription was based on guideline proposed by the Department of Clinical Pharmacy of Nemazee Hospital.Conclusions:Non-adherence to the guidelines occurred frequently in the ICUs of Nemazee hospital. Prescription of loading dose, and AGs level measurement were not done and evaluating microbiological data was often neglected. Incorporating pharmacists in the health care team and holding training programs for physicians and nurses with the goal of raising awareness about the proposed guideline.

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Appropriateness of vancomycin therapeutic drug monitoring and its outcomes among non-dialysis patients in a tertiary hospital in Singapore

Cited by 12 publications

References 10 publications

From Therapeutic Drug Monitoring to Model‐Informed Precision Dosing for Antibiotics

From Therapeutic Drug Monitoring to Model‐Informed Precision Dosing for Antibiotics

Long-term vancomycin use had low risk of ototoxicity

Evaluation of aminoglycosides utilization in intensive care units of a teaching hospital in southern Iran

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