Status and Quality of Guidelines for Therapeutic Drug Monitoring Based on AGREE II Instrument

Yi, Zhan-Miao; Li, Xinya; Wang, Zhitong; Qin, Jiguang; Jiang, Dan; Tian, Panhui; Yang, Ping; Zhao, Rongsheng

doi:10.1007/s40262-023-01283-x

Cited by 2 publications

(2 citation statements)

References 98 publications

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“…Level 3 includes drugs in which TDM can be used for special indications or problem solving, while level 4 refers to drugs for which the benefits of routinary TDM have not been established, but for which TDM could be potentially useful in particular cases [1]. A recent systematic review by Yi and colleagues evaluated the quality of more t 90 guidelines for TDM based on the Appraisal of Guidelines for Research and Evalua (AGREE) II Instrument [6,7]. Considering the TDM guidelines for Central Nerv System (CNS) drugs, the overall quality of Hiemke and colleagues' work was among highest, with a score of 66.67%.…”

Section: Introductionmentioning

confidence: 99%

“…A survey conducted in China among psychiatric facilities by Guo and colleag found that even when TDM was used to monitor the patients' drug levels, in most ca this was not followed with recommendations on dose adjustment, underlining the that sometimes there could be a lack of communication between clinicians and laborat professionals [14]. These findings show that there is still room for improvement in A recent systematic review by Yi and colleagues evaluated the quality of more than 90 guidelines for TDM based on the Appraisal of Guidelines for Research and Evaluation (AGREE) II Instrument [6,7]. Considering the TDM guidelines for Central Nervous System (CNS) drugs, the overall quality of Hiemke and colleagues' work was among the highest, with a score of 66.67%.…”

Section: Introductionmentioning

confidence: 99%

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Therapeutic Drug Monitoring in Psychiatry: Enhancing Treatment Precision and Patient Outcomes

Biso,

Aringhieri,

Carli

et al. 2024

Pharmaceuticals

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Psychiatric disorders often require pharmacological interventions to alleviate symptoms and improve quality of life. However, achieving an optimal therapeutic outcome is challenging due to several factors, including variability in the individual response, inter-individual differences in drug metabolism, and drug interactions in polytherapy. Therapeutic drug monitoring (TDM), by measuring drug concentrations in biological samples, represents a valuable tool to address these challenges, by tailoring medication regimens to each individual. This review analyzes the current landscape of TDM in psychiatric practice, highlighting its significance in optimizing drug dosages, minimizing adverse effects, and improving therapeutic efficacy. The metabolism of psychiatric medications (i.e., mood stabilizers, antipsychotics, antidepressants) often exhibits significant inter-patient variability. TDM can help address this variability by enhancing treatment personalization, facilitating early suboptimal- or toxic-level detection, and allowing for timely interventions to prevent treatment failure or adverse effects. Furthermore, this review briefly discusses technological advancements and analytical methods supporting the implementation of TDM in psychiatric settings. These innovations enable quick and cost-effective drug concentration measurements, fostering the widespread adoption of TDM as a routine practice in psychiatric care. In conclusion, the integration of TDM in psychiatry can improve treatment outcomes by individualizing medication regimens within the so-called precision medicine.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Therapeutic Drug Monitoring in Psychiatry: Enhancing Treatment Precision and Patient Outcomes

Biso,

Aringhieri,

Carli

et al. 2024

Pharmaceuticals

View full text Add to dashboard Cite

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Interprofessional Therapeutic Drug Monitoring of Carbapenems Improves ICU Care and Guideline Adherence in Acute-on-Chronic Liver Failure

Schmid,

Koch,

Zimmermann

et al. 2023

Antibiotics

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(1) Background: Acute-on-chronic liver failure (ACLF) is a severe, rapidly progressing disease in patients with liver cirrhosis. Meropenem is crucial for treating severe infections. Therapeutic drug monitoring (TDM) offers an effective means to control drug dosages, especially vital for bactericidal antibiotics like meropenem. We aimed to assess the outcomes of implementing TDM for meropenem using an innovative interprofessional approach in ACLF patients on a medical intensive care unit (ICU). (2) Methods: The retrospective study was conducted on a medical ICU. The outcomes of an interprofessional approach comprising physicians, hospital pharmacists, and staff nurses to TDM for meropenem in critically ill patients with ACLF were examined in 25 patients. Meropenem was administered continuously via an infusion pump after the application of an initial loading dose. TDM was performed weekly using high-performance liquid chromatography (HPLC). Meropenem serum levels, implementation of the recommendations of the interprofessional team, and meropenem consumption were analyzed. (3) Results: Initial TDM for meropenem showed a mean meropenem serum concentration of 20.9 ± 9.6 mg/L in the 25 analyzed patients. Of note, in the initial TDM, only 16.0% of the patients had meropenem serum concentrations within the respective target range, while 84.0% exceeded this range. Follow-up TDM showed serum concentrations of 15.2 ± 5.7 mg/L (9.0–24.6) in Week 2 and 11.9 ± 2.3 mg/L (10.2–13.5) in Week 3. In Week 2, 41.7% of the patients had meropenem serum concentrations that were within the respective target range, while 58.3% of the patients were above this range. In Week 3, 50% of the analyzed serum concentrations of meropenem were within the targeted range, and 50% were above the range. In total, 100% of the advice given by the interprofessional team regarding meropenem dosing or a change in antibiotic therapy was implemented. During the intervention period, the meropenem application density was 37.9 recommended daily doses (RDD)/100 patient days (PD), compared to 42.1 RDD/100 PD in the control period, representing a 10.0% decrease. (4) Conclusions: Our interprofessional approach to TDM significantly reduced meropenem dosing, with all the team’s recommendations being implemented. This method not only improved patient safety but also considerably decreased the application density of meropenem.

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Status and Quality of Guidelines for Therapeutic Drug Monitoring Based on AGREE II Instrument

Cited by 2 publications

References 98 publications

Therapeutic Drug Monitoring in Psychiatry: Enhancing Treatment Precision and Patient Outcomes

Therapeutic Drug Monitoring in Psychiatry: Enhancing Treatment Precision and Patient Outcomes

Interprofessional Therapeutic Drug Monitoring of Carbapenems Improves ICU Care and Guideline Adherence in Acute-on-Chronic Liver Failure

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