Clinical Outcomes of Vancomycin Therapy by the Protocol-Based Pharmacotherapy Management (PBPM) including TDM-Order

Abstract

Vancomycin (VCM) is a first-line antibiotic used for methicillin-resistant Staphylococcus aureus (MRSA), and therapeutic drug monitoring (TDM) is recommended to minimize the risk of nephrotoxicity and ensure successful therapeutic outcomes. In Kyoto University Hospital, we have developed a new approach of pharmacist intervention in the medication with VCM, which is named "Protocol-Based Pharmacotherapy Management (PBPM)." PBPM is based on a protocol approved in a hospital committee, which mentioned that pharmacists could order TDM and propose the most appropriate treatment plans with VCM to surgeons. From April 2011 to September 2014 in Kyoto University Hospital, a total of 54 patients hospitalized for cardiovascular surgeries received VCM without the treatment of hemodialysis. Twenty-nine patients before introducing PBPM were the control group. The VCM treatment according to PBPM was applied to 25 patients (protocol group). The incidence of acute kidney injury (AKI) due to VCM therapy, the retention rates of VCM blood concentration maintained in the therapeutic range (10-20 µg/mL) and in the toxic range (over 20 µg/mL) were retrospectively surveyed. The incidence of AKI was significantly lower in the protocol group than that in the control group (8.0％ vs 31.0％, P < 0.05). The retention rates maintained in the therapeutic blood concentration range and in the toxic blood concentration range were significantly different between the control group and the protocol group. These results demonstrate that pharmaceutical intervention based on PBPM for MRSA treatment is effective for maintaining VCM blood concentration in the therapeutic range, resulting in a reduction of adverse drug reactions.

New role of Japanese pharmacists focusing on medication therapy management in a team care approach

“…6 We conducted a literature search using the keyword 'PBPM' through J-STAGE, which is the Japanese database for scientific research that covers more than 2000 electronic journals, and found eight articles reporting that PBPM is reducing the burden for physicians, nurses and entire institutions, as well as increasing medication safety and patient satisfaction. [7][8][9][10][11][12][13][14] The new role for Japanese pharmacists in the team approach has expanded primarily among hospital pharmacists via PBPM. However, we propose that in our modern, aging society, the functions and roles of pharmacists practising in community pharmacies need to Box 1 Roles and functions that a pharmacist should provide in the team approach As a team member, the pharmacist may:…”