<p>A nationwide utilization survey of therapeutic drug monitoring for five antibiotics in South Korea</p>

Abstract

Purpose The current status of therapeutic drug monitoring (TDM) assay utilization by clinical laboratories in South Korea remains little known. We investigated the TDM status of five antibiotics known for nephrotoxicity (vancomycin, amikacin, gentamicin, tobramycin, and teicoplanin) for the improvement of TDM in South Korea among patients with infectious diseases using a cross-sectional nationwide survey. Patients and methods We developed an online questionnaire and collected responses using a user-friendly web-based platform. The survey included questions about laboratory characteristics, implementation and operation of drug assays, implementation and operation of TDM consulting services, patient needs, and barriers to providing better TDM service including expectations and concerns about other platform-based drug assays. Results Among a total of 235 clinical laboratories, 112 (47.7%) responded, and 62 of the responding laboratories (55.4%) possessed drug assay facilities. Only 41.2% to 58.1% of respondents were providing TDM consulting services for each antibiotic. Respondents indicated that there are unmet needs regarding drug assays and TDM consultation as well as barriers to TDM utilization including high operating costs, lack of knowledge about TDM, lack of user-friendly software, lack of medical and laboratory information systems that can access patient information critical for TDM dose calculation, and reimbursement issues. Conclusion This study, the first nationwide survey addressing these questions, showed that there are barriers against the utilization of TDM in South Korea. These barriers may be addressed by improving drug assays and TDM consulting services with the goals of new analytical method development, better interpretation of results, consultation services, and quality control.

Therapeutic Drug Monitoring and Pharmacogenetic Testing in Northern China

“…This study provides new information regarding the current status of TDM and PGx testing service in northern China. We found that TDM service was widely available in tertiary public hospitals in northern China, a result consistent with data from other countries ( Norris et al, 2010 ; Ab Rahman et al, 2013 ; Donna et al, 2018 ; Choi et al, 2019 ). The hospitals not providing TDM service were traditional Chinese medicine hospitals or ones with a smaller number of hospital beds.…”

“…However, not all hospitals in China have used PGx testing. Nationwide surveys of TDM services have been reported for other countries, including Australia, the United Kingdom, Italy, Norway, Canada and Malaysia ( Ab Rahman et al, 2013 ; Donna et al, 2018 ; Choi et al, 2019 ). Wei et al documented the status of TDM of psychiatric drugs in China ( Wei et al, 2013 ), but a nationwide survey on TDM and PGx testing in China has not been undertaken.…”

Individualized Vancomycin Dosing with Therapeutic Drug Monitoring and Pharmacokinetic Consultation Service: A Large-Scale Retrospective Observational Study

“…The revised consensus guidelines for TDM of vancomycin recommend AUC-guided dosing and monitoring for patients with suspected or definitive serious MRSA infections. 9 However, implementation of AUC monitoring is challenging in routine clinical practice (ie, investment in Bayesian software, training and education of pharmacists, physicians, phlebotomists, and nursing staff on the revised guidelines), 55 , 56 , 58 that a multicenter cross-sectional electronic survey showed that less than a quarter (18/78, 23.1%) of respondent medical centers were providing AUC-based monitoring. 56 Compared to AUC, monitoring trough concentration is easily applicable in medical centers with a readily available serum vancomycin concentration assay.…”

“… 56 Compared to AUC, monitoring trough concentration is easily applicable in medical centers with a readily available serum vancomycin concentration assay. 58 Moreover, although the evidence for the recommendations has been strengthened compared to the previous guideline and a number of studies have shown better efficacy and safety outcomes through AUC monitoring since the publication of the revised guideline 18 , 22 , 24 , 28 , 48 , 52–54 , 62–64 , there are no randomized controlled trials. Given the challenging prerequisites for implementing AUC monitoring and the absence of high-quality evidence, it is still difficult to endorse conversion from trough to AUC monitoring.…”

“… 55–58 In contrast to the considerable requirements for AUC monitoring, serum trough concentration is easily applicable on account of readily available serum vancomycin concentration assays, and many medical centers still monitor trough concentration. 58 …”