Mississippi Mud No More: Cost‐Effectiveness of Pharmacokinetic Dosage Adjustment of Vancomycin to Prevent Nephrotoxicity

Darko, William; Medicis, Joseph J.; Smith, Alexis Nicole; Guharoy, Roy; Lehmann, David F.

doi:10.1592/phco.23.5.643.32199

Cited by 73 publications

(42 citation statements)

References 21 publications

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“…The previous similar studies results were associated with shorter courses of therapy, less total doses of vancomicin and hospital stay [6,19,21]. In our work, there was a significant improvement in response achievement (p=0.015) in monitored group compared to non-monitored group.…”

Section: Discussionsupporting

confidence: 79%

“…On the other hand, vancomycin monitoring decreased the nephrotoxicity in VWM group compared to VWOM group (p=0.016) and reached a similar result of VF group [6,19,21]. This findings support the idea of monitoring vancomycin when added to the treatment of pediatric cancer patients.…”

Section: Discussionsupporting

confidence: 66%

“…Monitoring vancomycin serum trough level is recommended for patients with unstable renal function [19]; those receiving prolonged courses of therapy (more than three to five days) [9] and oncology patients [19,20].…”

Section: Discussionmentioning

confidence: 99%

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Is vancomycin monitoring of real value in pediatric cancer patients?

Imam¹,

Khaled²,

Abdelrahim³

et al. 2017

Med-Science

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Vancomycin is not nephrotoxic by itself but many patients using it with other nephrotoxic agents show nephrotoxicity to some extent. Whether to monitor or not to monitor vancomycin needs further study. The aim of the present study was to investigate the significance of monitoring vancomycin serum levels in pediatric patients treated from different malignancies. 150 newly diagnosed pediatric patients, with various types of malignancy treated with different nephrotoxic agents including vancomycin, were recruited in the study. All patients had normal renal functions at the start of the study and were divided into three groups; Group I included 50 (21 females) patients received vancomycin without monitoring (VWOM group); Group II included 50 (19 females) patients received vancomycin with monitoring (VWM group); Group III (Control group) included 50 (23 females) patients received vancomycin-free antimicrobial agents (VF group). Vancomycin trough level was determined only for VWM group. The effectiveness of monitoring was estimated by the ability to achieve more rapid response, decrease hospital stay and nephrotoxicity and its effect on total dose of vancomycin. There was a significant decrease in nephrotoxicity in VWM and VF groups, 9 subjects (18%), compared to 15 subjects (30%) in VWOM group (p=0.016). The time needed to show a response achievement was significantly decreased in VWM group compared to VWOM group with mean (SD) of 6.5 (2.5) and 8.7 (3.6) days, respectively (p=0.015). That led to shorter hospital stay in VWM group compared to VWOM group with mean (SD) of 10.1 (3.4) and 12.4 (4.2) days, respectively (p=0.003). Monitoring vancomycin level was important in the examined high risk groups of pediatric cancer patients studied.

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Section: Discussionsupporting

confidence: 79%

Section: Discussionsupporting

confidence: 66%

See 1 more Smart Citation

Is vancomycin monitoring of real value in pediatric cancer patients?

Imam¹,

Khaled²,

Abdelrahim³

et al. 2017

Med-Science

View full text Add to dashboard Cite

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“…1,2 Increasing evidence suggests that the current use of TDM is suboptimal, with up to 70% to 80% of drug quantifications in hospitalized patients being inappropriately performed, primarily because of routine daily monitoring without pharmacological justification. 3,4 Routine vancomycin TDM has been intensely debated, [5][6][7][8][9] and scrutiny has resulted in the publication of consensus guidelines in January 2009 by the American Society of Health-System Pharmacists, the Infectious Disease Society of America, and the Society of Infectious Disease Pharmacists. 1 These guidelines focused specifically on vancomycin TDM in adult patients.…”

Section: Introductionmentioning

confidence: 99%

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

Suryadevara

Steidl

Probst

et al. 2012

The Journal of Pediatric Pharmacology and Therapeutics

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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.INDEX TERMS antibiotic stewardship, therapeutic drug monitoring, vancomycin J Pediatr Pharmacol Ther 2012;17(2):159-165

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“…[1][2][3] It was reported that the adverse drug reactions of norvancomycin are similar to vancomycin, such as nephrotoxicity, ototoxicity, rash and itching. [4][5][6][7][8][9][10] Nephrotoxicity will result in serious consequences, especially in the patients who are aged, have kidney diseases or receive concomitant medication excreted from kidney such as aminoglycosides. 8,[11][12][13][14] So, norvancomycin treatment should be supported by TDM and individualized dosing regimen to decrease the occurrence of adverse reactions and improve efficacy.…”

Section: Introductionmentioning

confidence: 99%

Establishment of norvancomycin fluorescence polarization immunoassay for therapeutic drug monitoring

Zhang

et al. 2011

J Antibiot

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To establish a rapid and simple fluorescence polarization immunoassay method for determination of norvancomycin serum concentration, we collected 300 serum samples from the patients receiving norvancomycin in the hospitals localized in Shanghai, China. The drug concentrations were measured by the established HPLC method and FPIA with vancomycin kit. A FPIA algorithm for the determination of norvancomycin concentration was established according to the correlation between the FPIA and HPLC results. The methods and algorithm were validated in another 70 clinical samples. HPLC determination showed a good linear correlation within the range of 0.5-100 mg l À1 of norvancomycin concentrations. The method was validated via extraction recovery, intra-and inter-day methodological recovery and stability of norvancomycin in serum. Correlation analysis between the measurements of HPLC and FPIA in 300 serum samples gave the linear regression equation: (concentration by HPLC)¼0.760Â(concentration by FPIA)-0.577 (Po0.001, R 2 ¼0.982). An algorithm was derived from this correlation for measuring the serum norvancomycin concentrations with FPIA. When it was validated in additional 70 serum samples from patients, 'FPIA algorithm' showed good accuracy versus HPLC: 'FPIA algorithm'¼0.93 (HPLC)+0.63, R 2 ¼0.962, and 94.3% of the results from FPIA algorithm fell within the range of À20%/+20% of HPLC. This algorithm developed in this study can be easily used for determination of norvancomycin using TDx analyzer with vancomycin kit indirectly. It may also be useful for norvancomycin therapeutic drug monitoring.

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Mississippi Mud No More: Cost‐Effectiveness of Pharmacokinetic Dosage Adjustment of Vancomycin to Prevent Nephrotoxicity

Cited by 73 publications

References 21 publications

Is vancomycin monitoring of real value in pediatric cancer patients?

Is vancomycin monitoring of real value in pediatric cancer patients?

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

Establishment of norvancomycin fluorescence polarization immunoassay for therapeutic drug monitoring

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