Sampling time and indications appropriateness for therapeutically monitored drugs at a teaching university hospital in Oman

Za’abi, Mohammed Al; Muqbali, Juhina Al; Al-Waili, Khalid

doi:10.1016/j.jsps.2014.11.005

Cited by 11 publications

(12 citation statements)

References 14 publications

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“…Our findings are consistent with the few available vancomycin TDM audits in the MENA region and elsewhere . Al‐Zaabi and colleagues reported two studies in Oman that were conducted at two different time points .…”

Section: Discussionsupporting

confidence: 90%

“…Most vancomycin TDM requests were appropriately indicated but inappropriately timed . Moreover, dosage adjustments were applied in many incorrectly sampled specimens, suggesting false dosing and inappropriate interpretation of TDM results . Consistent with our findings, higher tendency to apply dosage adjustments in response to supratherapeutic concentrations rather than subtherapeutic concentrations has been reported .…”

Section: Discussionsupporting

confidence: 83%

“…Consistent with our findings, higher tendency to apply dosage adjustments in response to supratherapeutic concentrations rather than subtherapeutic concentrations has been reported . Nevertheless, the clinical implications of such practices were not assessed in the previous studies, and documentation quality was not reported . Dose adjustment practices were insufficient in an Iranian hospital, and were not based on vancomycin concentrations, which may explain the relatively high rates of nephrotoxicity and supratherapeutic levels reported in their setting .…”

Section: Discussionsupporting

confidence: 73%

“…Al‐Zaabi and colleagues reported two studies in Oman that were conducted at two different time points . Most vancomycin TDM requests were appropriately indicated but inappropriately timed . Moreover, dosage adjustments were applied in many incorrectly sampled specimens, suggesting false dosing and inappropriate interpretation of TDM results .…”

Section: Discussionmentioning

confidence: 99%

See 3 more Smart Citations

Vancomycin therapeutic drug monitoring service quality indices and clinical effectiveness outcomes: A retrospective cohort and clinical audit

Al-Sulaiti

Nader

Elmekaty

et al. 2020

J Am Coll Clin Pharm

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Introduction:Vancomycin is commonly used for the treatment of complicated infections caused by methicillin-resistant Staphylococcus aureus. The impact of vancomycin therapeutic drug monitoring (TDM) quality indices on clinical outcomes has not been previously explored.Objectives: This study aims to relate routine vancomycin TDM service quality indices to clinical effectiveness outcomes and to develop a pragmatic vancomycin-specific TDM quality assessment tool that can be used in quality audits.Methods: A retrospective chart review was conducted on adult non-dialysis vancomycin TDM records documented between January 2014 and October 2016 in three tertiary care hospitals under Hamad Medical Corporation (HMC) in Qatar. Evidencebased criteria and pilot-testing were applied to develop a quality assessment tool.The appropriateness of vancomycin TDM service and clinical outcomes were simultaneously evaluated.Results: A 13-criterion vancomycin TDM quality assessment tool was developed and used to evaluate 208 TDM records involving 99 patients. The indications for TDM requests were judged appropriate in 77.4% (n = 161) of the records. However, most of the blood samples were deemed to be incorrectly timed (70.7%, n = 147). Inappropriate vancomycin TDM practices compared with appropriate practices were associated with lower therapeutic cure (47.3% vs 75%, P-value = .009).Conclusions: Vancomycin TDM requests were justified at HMC. However, inappropriate practices were associated with suboptimal clinical outcomes, signifying the importance of routine quality audits using rigorous evaluation tools. The developed tool can be used to determine setting-specific deficiencies in routine vancomycin TDM practices.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionsupporting

confidence: 83%

Section: Discussionsupporting

confidence: 73%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Vancomycin therapeutic drug monitoring service quality indices and clinical effectiveness outcomes: A retrospective cohort and clinical audit

Al-Sulaiti

Nader

Elmekaty

et al. 2020

J Am Coll Clin Pharm

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“…The purpose of TDM is to individualise the therapeutic regimen of the patient to gain optimal benefit with the lowest toxicity. Research has shown blood samples for TDM purposes are not always taken correctly and protocols do not exist, or are not always followed,2 which can lead to incorrect dosing regimens and waste of time and resources, especially in developing countries 2…”

Section: Introductionmentioning

confidence: 99%

Standards of aminoglycoside therapeutic drug monitoring in a South African private hospital: perspectives and implications

Toit¹,

Burger²,

Rakumakoe³

et al. 2019

Ghana Medical Journal

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Summary Background Therapeutic drug monitoring (TDM) is essential to ensure that aminoglycoside peak concentrations are high enough for effective antimicrobial treatment and trough levels are low enough to minimise toxicity. Inappropriate utilisation of TDM may lead to suboptimal therapy, toxicity and waste of resources. This study aimed to investigate the standard of aminoglycoside TDM performed in adult hospitalised patients. Design An observational, descriptive, cross-sectional study. Setting A 221-bed private hospital. Participants All patients, older than 18 years, on intravenous aminoglycosides for more than 48 hours were included. Interventions None, was observational. A computerised database and patient files were used to obtain the information required for this study. Descriptive statistical analysis was used. Main outcomes measures Aminoglycoside blood levels and estimated glomerular filtration rate (eGFR) in the patients. Results One hundred and three (103) patients were included: 65 on gentamicin and 38 on amikacin. Blood levels were performed in only 19 gentamicin (29.23%) and 22 amikacin (57.89%) patients. Trough levels were taken more than 2 hours before the next dose in 12 gentamicin (63.16%) and 12 amikacin (54.54%) patients. The majority of patients (96.92% on gentamicin and 84.21% on amikacin) received once daily doses. TDM was performed in all patients with an estimated glomerular filtration rate (eGFR) lower than 60 mL/min/1.73m 2 and in 23.31% of gentamicin patients and 56.76% of amikacin patients with an eGFR higher than 60 mg/min/1.73m 2 . Conclusions Incorrect sampling times and unnecessary levels taken in patients with normal renal function indicate a need for aminoglycoside treatment guidelines in the private hospital. Funding None

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Evaluation of a Pilot Vancomycin Precision Dosing Advisory Service on Target Exposure Attainment Using an Interrupted Time Series Analysis

Stocker

Carland

Reuter

et al. 2020

Clin Pharma and Therapeutics

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Sampling time and indications appropriateness for therapeutically monitored drugs at a teaching university hospital in Oman

Abstract: TDM service is much less than optimal in SQUH. A lot of effort needs to be carried out to improve TDM use in the developing countries as adjusting the doses on results that are based on wrong sampling time might expose patients to toxicity or therapeutic failure.

Cited by 11 publications

References 14 publications

Vancomycin therapeutic drug monitoring service quality indices and clinical effectiveness outcomes: A retrospective cohort and clinical audit

Vancomycin therapeutic drug monitoring service quality indices and clinical effectiveness outcomes: A retrospective cohort and clinical audit

Standards of aminoglycoside therapeutic drug monitoring in a South African private hospital: perspectives and implications

Evaluation of a Pilot Vancomycin Precision Dosing Advisory Service on Target Exposure Attainment Using an Interrupted Time Series Analysis

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