scholarly journals Therapeutic Drug Monitoring of Voriconazole in Children from a Tertiary Care Center in China

2018 ◽  
Vol 62 (12) ◽  
Author(s):  
Lin Hu ◽  
Ting-ting Dai ◽  
Le Zou ◽  
Tao-ming Li ◽  
Xuan-sheng Ding ◽  
...  
Keyword(s):  
Therapeutic Drug Monitoring ◽  
Drug Monitoring ◽  
Care Center ◽  
Tertiary Care ◽  
Target Range ◽  
Therapeutic Drug ◽  
Affecting Factors ◽  
Administration Routes ◽  
Asian Children ◽  
Trough Concentrations

ABSTRACT Voriconazole is a broad-spectrum triazole antifungal and the first-line treatment for invasive aspergillosis (IA). The aim of this research was to study the dose adjustments of voriconazole as well as the affecting factors influencing voriconazole trough concentrations in Asian children to optimize its daily administration. Clinical data were analyzed of inpatients 2 to 14 years old who were subjected to voriconazole trough concentration monitoring from 1 June 2015 to 1 December 2017. A total of 138 voriconazole trough concentrations from 42 pediatric patients were included. Voriconazole trough concentrations at steady state ranged from 0.02 to 9.35 mg/liter, with high inter- and intraindividual variability. Only 50.0% of children achieved the target range (1.0 to 5.5 mg/liter) at initial dosing, while 35.7% of children were subtherapeutic, and 14.3% of children were supratherapeutic at initial dosing. There was no correlation between initial trough concentrations and initial dosing. A total of 28.6% of children (12/42) received an adjusted dose according to trough concentrations. Children <6, 6 to 12, and >12 years old required a median oral maintenance dose to achieve the target range of 11.1, 7.2, and 5.3 mg/kg twice daily, respectively (P = 0.043). The average doses required to achieved the target range were 7.7 mg/kg and 5.6 mg/kg, respectively, and were lower than the recommended dosage (P = 0.033 and 0.003, respectively). Affecting factors such as administration routes and coadministration with proton pump inhibitors (PPIs) explained 55.3% of the variability in voriconazole exposure. Therapeutic drug monitoring (TDM) of voriconazole could help to individualize antifungal therapy for children and provide guidelines for TDM and dosing optimization in Asian children.

scholarly journals Inappropriate Vancomycin Therapeutic Drug Monitoring in Hospitalized Pediatric Patients Increases Pediatric Trauma and Hospital Costs

2012 ◽  
Vol 17 (2) ◽  
pp. 159-165 ◽  
Author(s):  
Manika Suryadevara ◽  
Kelly E. Steidl ◽  
Luke A. Probst ◽  
Jana Shaw
Keyword(s):  
Health Care ◽  
Therapeutic Drug Monitoring ◽  
Health Care Provider ◽  
Care Provider ◽  
Drug Monitoring ◽  
Hospital Cost ◽  
Pediatric Patients ◽  
Tertiary Care ◽  
Therapeutic Drug ◽  
Trough Concentrations

OBJECTIVES The objective of this study was to measure the appropriateness of vancomycin monitoring in a pediatric tertiary care center and to evaluate the effectiveness of two interventions, autonomous pharmacy therapeutic drug monitoring and health care provider education, in reducing avoidable pediatric patient trauma and hospital cost. METHODS A retrospective chart review evaluating vancomycin therapeutic drug monitoring (TDM) in pediatric inpatients was performed before and after the introduction of an autonomous pharmacy TDM program and health care provider (HCP) education. RESULTS Thirty-five patients were included in our study, prior to any intervention. Of these, 9% of patients had trough concentrations appropriately deferred. Of the total of 64 trough concentrations obtained, 94% were considered to be inappropriate. After the start of the autonomous pharmacy TDM program, of the 54 eligible patients (111 troughs), 9% had trough concentrations appropriately deferred, and 34% were inappropriate. In the 3-month period following the introduction of HCP education in combination with pharmacy TDM, we identified 27 eligible patients. Among those, 15% of the patients had trough concentrations appropriately deferred. Of the 43 trough concentrations obtained, only 9% were considered to be inappropriate. The combination of pharmacy TDM with HCP education decreased annualized hospital cost by 60%, from $13,080 to $5232. CONCLUSIONS Inappropriate vancomycin TDM occurs commonly in our institution, resulting in unnecessary hospital cost and patient trauma. The combination of pharmacy TDM and HCP education significantly improved clinical practice; however, results were short-lived. Further interventions, such as computer based order entry, will likely be needed to reinforce and improve long-term TDM practice in pediatric patients.

Therapeutic Drug Monitoring of Antiepileptic Drugs in a Tertiary Care Hospital in India

2015 ◽  
Vol 38 (1) ◽  
pp. 1-5 ◽  
Author(s):  
Natarajan Harivenkatesh ◽  
Natarajan Haribalaji ◽  
Darling Chellathai David ◽  
C. M. Prabu Kumar
Keyword(s):  
Therapeutic Drug Monitoring ◽  
Antiepileptic Drugs ◽  
Drug Monitoring ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Therapeutic Drug ◽  
Care Hospital

scholarly journals Therapeutic Drug Monitoring of Voriconazole in AIDS Patients

2021 ◽  
Author(s):  
Tingting Chen ◽  
Zhiqiang Lin ◽  
Huatang Zhang ◽  
Qingquan Zhang ◽  
Limian Hong ◽  
...  
Keyword(s):  
Therapeutic Drug Monitoring ◽  
Drug Interactions ◽  
Therapeutic Range ◽  
Trough Concentration ◽  
Drug Monitoring ◽  
Linear Regression Analysis ◽  
Immune Deficiency Syndrome ◽  
Therapeutic Drug ◽  
Affecting Factors ◽  
Aids Patients

Abstract Background The safety and efficacy of Voriconazole in Acquired Immune Deficiency Syndrome (AIDS) patients is difficult to guarantee. In this study, Therapeutic Drug Monitoring (TDM) of Voriconazole in AIDS patients was investigated with the aim to further verify the significance of voriconazole TDM in AIDS patients and to explore more strategies to improve individualized medication. Methods The data of AIDS patients who underwent voriconazole TDM in our hospital from May 2018 to August 2021 were collected. The basic information of patients, the results of voriconazole TDM, the individualized intervention, the affecting factors of voriconazole concentration were analyzed, as well as the relationship between voriconazole trough concentration and safety. Results A total of 46 tests of voriconazole TDM were performed in 28 AIDS patients. Only 57.14% patients reached the therapeutic range at first TDM, and 87.50% patients reached the therapeutic range after intervention based on first TDM. 21.43% patients develop voriconazole-related Adverse Drug Reactions (ADRs), and ADRs were mostly occurred when voriconazole concentration is above 5.0 µg/mL. Spearman correlation coefficient rs was calculated to be 0.729 for voriconazole trough concentration and the incidence of ADRs, exhibiting a significant, positive linear correlation (P=0. 017). 50% patients had polypharmacy and drug interactions are common. For example, rifampicin can significantly reduce the plasma concentration of voriconazole. Multiple linear regression analysis showed Hypoproteinemia was a significant factor affecting voriconazole trough concentration(P=0.006). Conclusion AIDS patients usually have a low attainment rate of voriconazole trough concentration after initiation of standard dosing regimen. The affecting factors seem multifactorial and complex, of which hypoproteinemia is of great significance. Meanwhile, we need to be alert to the effects of drug interactions. The incidence of voriconazole related ADRs is high, mostly occurring when voriconazole concentration is above 5.0 µg/mL. Therefore, TDM can provide meaningful guidance for dosage optimization of voriconazole, and the dosage adjustment method in Chinese Guideline is applicable for the population of AIDS patients.

Intra-individual variability in lopinavir plasma trough concentrations supports therapeutic drug monitoring

AIDS ◽  
2003 ◽  
Vol 17 (7) ◽  
pp. 1107-1108 ◽  
Author(s):  
Marta Boffito ◽  
David J Back ◽  
Patrick G Hoggard ◽  
Annamaria Caci ◽  
Stefano Bonora ◽  
...  
Keyword(s):  
Therapeutic Drug Monitoring ◽  
Drug Monitoring ◽  
Individual Variability ◽  
Therapeutic Drug ◽  
Trough Concentrations

Pediatric Pharmacokinetics and Therapeutic Drug Monitoring

1992 ◽  
Vol 13 (11) ◽  
pp. 413-421
Author(s):  
Howard L. McLeod ◽  
William E. Evans
Keyword(s):  
Therapeutic Drug Monitoring ◽  
Drug Monitoring ◽  
Therapeutic Response ◽  
Rational Approach ◽  
Target Range ◽  
Therapeutic Drug ◽  
Plasma Drug ◽  
Toxic Response ◽  
Drug Concentrations ◽  
Plasma Drug Concentrations

Recent advances in pediatric clinical pharmacology have provided a more rational approach to using several medications in children. An increased understanding of the effect of human development, concurrent medications, organ function, and disease states on the absorption, distribution, metabolism, and excretion of drugs has provided a stronger scientific basis for determining drug dosages in children. By measuring drug concentrations and utilizing pharmacokinetic and pharmacodynamic principles, the probability of therapeutic response can be enhanced for a number of medications. Likewise, therapeutic drug monitoring can minimize the risk of adverse effects from many drugs used in children. However, it must be recognized that toxicity can occur in some patients even though plasma drug concentrations are in the therapeutic range; similarly, some patients may not experience a therapeutic effect when plasma drug concentrations are in the same target range. Therefore, achieving the desired plasma concentration of a drug can enhance both the probability of a therapeutic response and diminish the probability of a toxic response. Therapeutic ranges, however, are only intermediate endpoints that must be used in the context of additional criteria to assess the clinical efficacy of any given drug therapy.

Current use of daptomycin and systematic therapeutic drug monitoring: Clinical experience in a tertiary care institution

2019 ◽  
Vol 53 (1) ◽  
pp. 40-48 ◽  
Author(s):  
Alicia Galar ◽  
Patricia Muñoz ◽  
Maricela Valerio ◽  
Emilia Cercenado ◽  
Xandra García-González ◽  
...  
Keyword(s):  
Therapeutic Drug Monitoring ◽  
Clinical Experience ◽  
Drug Monitoring ◽  
Tertiary Care ◽  
Therapeutic Drug ◽  
Care Institution ◽  
Tertiary Care Institution

scholarly journals Use of Therapeutic Drug Monitoring to Characterize Cefepime-Induced Neurotoxicity

2020 ◽  
Author(s):  
Veena Venugopalan ◽  
Cara Nys ◽  
Natalie Hurst ◽  
Yiqing Chen ◽  
Maria Bruzzone ◽  
...  
Keyword(s):  
Renal Function ◽  
Therapeutic Drug Monitoring ◽  
Trough Concentration ◽  
Drug Monitoring ◽  
Hospitalized Patients ◽  
Therapeutic Drug ◽  
Eeg Abnormalities ◽  
Increased Risk ◽  
Trough Concentrations ◽  
The Relationship

AbstractBackgroundThe incidence of cefepime-induced neurotoxicity (CIN) in hospitalized patients is highly variable. Although greater cefepime exposures incite neurotoxicity, data evaluating trough thresholds associated with CIN remains limited. The objectives of this study were to evaluate the incidence of CIN, assess the relationship between cefepime trough concentrations and CIN, investigate clinical factors associated with CIN, and describe electroencephalogram (EEG) abnormalities in CIN.MethodsThis was a retrospective study of adult patients who had received ≥ 5 days of cefepime with ≥ 1 trough concentration > 25 mg/L. Potential CIN cases were identified utilizing neurological symptoms, neurologist assessments, EEG findings and improvement of neurotoxicity after cefepime discontinuation.ResultsOne-hundred and forty-two patients were included. The incidence of CIN was 13% (18/142). The mean cefepime trough concentration in CIN patients was significantly greater than the non-neurotoxicity group (74.2 mg/L ± 41.1 vs. 46.6 mg/L ± 23, p=0.015). Lower renal function (creatinine clearance < 30 ml/min), greater time to therapeutic drug monitoring (TDM) (≥72 hours), and each 1 mg/mL rise in cefepime trough were independently associated with increased risk of CIN. Moderate generalized slowing of the background rhythm was the most common EEG pattern associated with CIN.ConclusionCefepime should be used cautiously in hospitalized patients due to the risk of neurotoxicity. Patients with greater renal function and those who had early cefepime TDM (≤ 72 hours) had lower risk of CIN.

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