Clinical practice guidelines for therapeutic drug monitoring of teicoplanin: a consensus review by the Japanese Society of Chemotherapy and the Japanese Society of Therapeutic Drug Monitoring
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- Yuki Hanai
- Department of Pharmacy, Toho University Omori Medical Center, Tokyo, Japan
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- Yoshiko Takahashi
- Department of Pharmacy, Hyogo College of Medicine, Nishinomiya, Japan
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- Takashi Niwa
- Department of Pharmacy, Gifu University Hospital, Gifu, Japan
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- Toshihiko Mayumi
- Department of Emergency Medicine, School of Medicine, University of Occupational and Environmental Health, Fukuoka, Japan
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- Yukihiro Hamada
- Department of Pharmacy, Tokyo Women’s Medical University Hospital, Tokyo, Japan
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- Toshimi Kimura
- Department of Pharmacy, Tokyo Women’s Medical University Hospital, Tokyo, Japan
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- Kazuaki Matsumoto
- Division of Pharmacodynamics, Keio University Faculty of Pharmacy, Tokyo, Japan
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- Satoshi Fujii
- Department of Hospital Pharmacy, Sapporo Medical University Hospital, Hokkaido, Japan
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- Yoshio Takesue
- Department of Infection Control and Prevention, Hyogo College of Medicine, Nishinomiya, Japan
説明
<jats:title>Abstract</jats:title><jats:sec><jats:title>Background</jats:title><jats:p>Owing to its low risk of adverse effects, teicoplanin has been extensively used in patients with infections caused by MRSA. To promote the better management of patients receiving teicoplanin, we have updated the guidelines for therapeutic drug monitoring (TDM).</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>The guidelines were developed by a committee following the methodology handbook published by the Japanese Medical Information Distribution Service. Nine clinical questions were selected. The committee conducted a systematic review and meta-analysis to establish evidence-based recommendations for the target trough concentration (Cmin). An initial electronic database search returned 515 articles, and 97 articles qualified for a full review. Four and five studies were included for the efficacy evaluation of cut-off Cmin values of 15 and 20 mg/L, respectively.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Compared with Cmin < 15 mg/L, a target Cmin value of 15–30 mg/L resulted in increased clinical efficacy in patients with non-complicated MRSA infections (OR = 2.68; 95% CI = 1.14–6.32) without an increase in adverse effects. Although there was insufficient evidence, target Cmin values of 20–40 mg/L were suggested in patients with complicated or serious MRSA infections. A 3 day loading regimen followed by maintenance treatment according to renal function was recommended to achieve the target trough concentrations. Because of the prolonged half-life of teicoplanin, measurement of the Cmin value on Day 4 before reaching steady state was recommended.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>The new guideline recommendations indicate the target Cmin value for TDM and the dosage regimen to achieve this concentration and suggest practices for specific subpopulations.</jats:p></jats:sec>
収録刊行物
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- Journal of Antimicrobial Chemotherapy
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Journal of Antimicrobial Chemotherapy 77 (4), 869-879, 2022-01-12
Oxford University Press (OUP)