In Malaysia, therapeutic drug monitoring (TDM) service was started in the 1980s. Since then, the number of hospitals that offer the service has increased. In this paper, we report the findings of a nationwide survey describing the practice of TDM in these hospitals. Questionnaires were mailed to 128 government hospitals. Data were collected for general characteristics of the hospitals, administrative, and laboratory activities related to TDM service. One hundred and twenty-one hospitals responded to the survey. Thirty-four hospitals (28.1%) provided the service with their own TDM laboratories, 44 hospitals (36.4%) provided the service using other hospitals' laboratories and 43 hospitals (35.5%) did not provide the service at all. TDM services were more likely to be offered in larger hospitals with various medical specialties. Since it is managed entirely by hospital pharmacists, these pharmacists assume an important role in ensuring optimum use of the TDM service.

*Background: Therapeutic drug monitoring (TDM) makes use of serum drug concentrations as an adjunct to decision-making. Preliminary data in our hospital showed that approximately one-fifth of all drugs monitored by TDM service were gentamicin. Objective: In this study, we evaluated the costs associated with providing the service in patients with bronchopneumonia and treated with gentamicin. Methods: We retrospectively collected data from medical records of patients admitted to the Hospital Universiti Sains Malaysia over a 5-year period. These patients were diagnosed with bronchopneumonia and were on gentamicin as part of their treatment. Five hospitalisation costs were calculated; (i) cost of laboratory and clinical investigations, (ii) cost associated with each gentamicin dose, (iii) fixed and operating costs of TDM service, (iv) cost of providing medical care, and (v) cost of hospital stay during gentamicin treatment. Results: There were 1920 patients admitted with bronchopneumonia of which 67 (3.5%) had TDM service for gentamicin. Seventy-three percent (49/67) patients were eligible for final analysis. The duration of gentamicin therapy ranged from 3 to 15 days. The cost of providing one gentamicin assay was MYR25, and the average cost of TDM service for each patient was MYR104. The average total hospitalisation cost during gentamicin treatment for each patient was MYR442 (1EUR approx. MYR4.02). Conclusion: Based on the hospital perspective, in patients with bronchopneumonia and treated with gentamicin, the provision of TDM service contributes to less than 25% of the total cost of hospitalization.

Objective: In Malaysia, therapeutic drug monitoring (TDM) service started in the late 1980s. Serum concentration measurements depend on commercially available drug assays, which are costly. In the present study, we attempted to document the impact of TDM service on cost and patient outcomes. Materials and Methods:We reviewed the medical records of the patients who were admitted to the hospital over a five-year period, diagnosed with bronchopneumonia and treated with gentamicin. Outcome measures were duration of fever, incidence of nephrotoxicity and length of hospital stay. We calculated the costs of laboratory and clinical investigations, the costs associated with the administration of gentamicin doses, the cost of providing TDM services, the costs associated with medical care by professional staff and the costs of hospital stays during gentamicin treatment. Results:Sixty-six patients were found to meet the inclusion criteria (10 patients were provided with TDM service and 56 patients were not). There was no significant difference in the duration of fever or the length of hospital stay during gentamicin therapy between the two groups. Although serum creatinine levels were not checked in all of the patients after gentamicin therapy, the data analysis did not show any cases of nephrotoxicity. There was no significant difference in the costs of laboratory investigations, the total cost of gentamicin therapy and the costs associated with professional staff between the two groups. The cost of the hospital stay during gentamicin therapy and the total cost of hospitalization were significantly higher in the TDM group. Conclusion:Evaluation in patients with bronchopneumonia shows that TDM in our setting was associated with higher cost; however, we did not observe any significant differences in the clinical outcomes. Gereç ve Yöntem:Beş yıl içinde hastaneye başvuran bronkopnö-moni tanısı ve gentamisin ile tedavi edilen hastaların tıbbi kayıtları incelendi. Araştırmanın çıktılarında nefrotoksisite ve hastanede yatış süresini ateş, sıklığı süresi mevcuttu. Laboratuvar ve klinik araştırma-ların maliyeti, gentamisin dozlarda uygulanması ile ilgili maliyetleri, TDM hizmetlerini sağlamanın maliyetinin, profesyonel personel tarafından tıbbi bakım ile ilgili maliyetler ve gentamisin tedavisi sırasında hastane masrafları hesaplanmıştır. Bulgular:Dahil edilme kriterlerine uygun 66 hasta incelenmiştir (10 hasta TDM hizmeti almmış ve 56 hasta almamıştır). İki grup arasında gentamisin tedavisi sırasında ateş veya hastanede kalış süresini açı-sından anlamlı fark bulunmamıştır. Gentamisin tedavisi sonrasında hastaların serum kreatinin düzeyleri tümünde kontrol edilmemekle birlikte, veri analizinde nefrotoksisite vakası görülmemiştir. Laboratuvar tetkikleri, gentamisin tedavisi ve iki grup arasında profesyonel kadrosu ile ilişkili maliyetlerin toplam maliyetinin maliyetleri açısın-dan anlamlı bir fark bulunmamıştır. Gentamisin tedavisi sırasında hastanede kalmak maliyeti ve toplam hastane maliyeti TDM grubunda anlamlı derecede...