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  1. Article ; Online: Optimization of Antimicrobial Stewardship Programs Using Therapeutic Drug Monitoring and Pharmacokinetics-Pharmacodynamics Protocols: A Cost-Benefit Review.

    Telles, João Paulo / Morales, Ronaldo / Yamada, Carolina Hikari / Marins, Tatiana A / D'Amaro Juodinis, Vanessa / Sztajnbok, Jaques / Silva, Moacyr / Bassetti, Bil Randerson / Albiero, James / Tuon, Felipe Francisco

    Therapeutic drug monitoring

    2023  Volume 45, Issue 2, Page(s) 200–208

    Abstract: Purpose: Antimicrobial stewardship programs are important for reducing antimicrobial resistance because they can readjust antibiotic prescriptions to local guidelines, switch intravenous to oral administration, and reduce hospitalization times. ... ...

    Abstract Purpose: Antimicrobial stewardship programs are important for reducing antimicrobial resistance because they can readjust antibiotic prescriptions to local guidelines, switch intravenous to oral administration, and reduce hospitalization times. Pharmacokinetics-pharmacodynamics (PK-PD) empirically based prescriptions and therapeutic drug monitoring (TDM) programs are essential for antimicrobial stewardship, but there is a need to fit protocols according to cost benefits. The cost benefits can be demonstrated by reducing toxicity and hospital stay, decreasing the amount of drug used per day, and preventing relapses in infection. Our aim was to review the data available on whether PK-PD empirically based prescriptions and TDM could improve the cost benefits of an antimicrobial stewardship program to decrease global hospital expenditures.
    Methods: A narrative review based on PubMed search with the relevant studies of vancomycin, aminoglycosides, beta-lactams, and voriconazole.
    Results: TDM protocols demonstrated important cost benefit for patients treated with vancomycin, aminoglycosides, and voriconazole mainly due to reduce toxicities and decreasing the hospital length of stay. In addition, PK-PD strategies that used infusion modifications to meropenem, piperacillin-tazobactam, ceftazidime, and cefepime, such as extended or continuous infusion, demonstrated important cost benefits, mainly due to reducing daily drug needs and lengths of hospital stays.
    Conclusions: TDM protocols and PK-PD empirically based prescriptions improve the cost-benefits and decrease the global hospital expenditures.
    MeSH term(s) Humans ; Aminoglycosides ; Anti-Bacterial Agents/therapeutic use ; Antimicrobial Stewardship ; Ceftazidime ; Cost-Benefit Analysis ; Drug Monitoring ; Vancomycin/therapeutic use ; Voriconazole
    Chemical Substances Aminoglycosides ; Anti-Bacterial Agents ; Ceftazidime (9M416Z9QNR) ; Vancomycin (6Q205EH1VU) ; Voriconazole (JFU09I87TR)
    Language English
    Publishing date 2023-01-02
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 424443-6
    ISSN 1536-3694 ; 0163-4356
    ISSN (online) 1536-3694
    ISSN 0163-4356
    DOI 10.1097/FTD.0000000000001067
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    In stock of ZB MED Cologne/Königswinter

    Zs.A 1503: Show issues Location:
    Je nach Verfügbarkeit (siehe Angabe bei Bestand)
    bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular
    Jg. 1995 - 2021: Lesesall (1.OG)
    ab Jg. 2022: Lesesaal (EG)

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  2. Article ; Online: Trough-guided Versus AUC/MIC-Guided Vancomycin Monitoring: A Cost Analysis.

    Morales Junior, Ronaldo / Tiguman, Gustavo Magno Baldin / D'Amaro Juodinis, Vanessa / Santos, Isabela Cristina Pinheiro de Freitas / Leite, Fernanda Soares / Vercelino, Juçara Guiçardi / de Lima, Bruna Diniz / Barbosa, Livia Maria Goncalves

    Clinical therapeutics

    2022  Volume 44, Issue 9, Page(s) e91–e96

    Abstract: Purpose: Recent vancomycin dosing and monitoring guidelines recommend monitoring vancomycin area under the 24-hour time-concentration curve instead of traditional trough-only monitoring. This study aimed to compare the total costs of vancomycin dosing ... ...

    Abstract Purpose: Recent vancomycin dosing and monitoring guidelines recommend monitoring vancomycin area under the 24-hour time-concentration curve instead of traditional trough-only monitoring. This study aimed to compare the total costs of vancomycin dosing and monitoring between trough-guided and AUC-guided approaches in a quaternary hospital from Brazil.
    Methods: In this retrospective cohort study, patients were divided into 2 groups according to the monitoring method. Patients with previous renal impairment were excluded. Vancomycin AUC was estimated by using 2 steady-state serum concentrations and first-order kinetics equations. The primary outcome was total cost of vancomycin therapy and monitoring from the hospital perspective, which included costs of cumulative doses, laboratory fees, materials used in blood collection, nursing time for collection, and pharmacist time for result interpretation.
    Findings: A total of 68 patients were included in the AUC/MIC-guided monitoring group, and 76 patients were included in the trough-guided monitoring group. There were no significant differences between groups regarding baseline serum creatinine level, duration of vancomycin therapy, and cumulative vancomycin dose. The median (interquartile range) total vancomycin drug and monitoring cost was $298.32 ($153.81-$429.85) for the AUC/MIC-guided group compared with $285.59 ($198.81-$435.57) for the trough-guided group (P = 0.9658).
    Implications: Vancomycin AUC estimation using 2 steady-state serum concentrations and first-order kinetics equations is a feasible alternative for limited-resource institutions that intend to transition from a trough approach to AUC/MIC-guided monitoring.
    MeSH term(s) Anti-Bacterial Agents/therapeutic use ; Area Under Curve ; Costs and Cost Analysis ; Creatinine ; Drug Monitoring/methods ; Humans ; Microbial Sensitivity Tests ; Retrospective Studies ; Staphylococcal Infections/drug therapy ; Vancomycin/therapeutic use
    Chemical Substances Anti-Bacterial Agents ; Vancomycin (6Q205EH1VU) ; Creatinine (AYI8EX34EU)
    Language English
    Publishing date 2022-08-26
    Publishing country United States
    Document type Journal Article
    ZDB-ID 603113-4
    ISSN 1879-114X ; 0149-2918
    ISSN (online) 1879-114X
    ISSN 0149-2918
    DOI 10.1016/j.clinthera.2022.07.012
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    In stock of ZB MED Cologne/Königswinter

    Zs.A 1435: Show issues Location:
    Je nach Verfügbarkeit (siehe Angabe bei Bestand)
    bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular
    Jg. 1995 - 2021: Lesesall (1.OG)
    ab Jg. 2022: Lesesaal (EG)
    Zs.MO 404: Show issues

    Order via subito

    This service is chargeable due to the Delivery terms set by subito. Orders including an article and supplementary material will be classified as separate orders. In these cases, fees will be demanded for each order.

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