Evaluation of a Pilot Vancomycin Precision Dosing Advisory Service on Target Exposure Attainment Using an Interrupted Time Series Analysis
| Autor: | Sophie L. Stocker, Deborah Marriott, Cindy Lau, Maurizio Stefani, Ranita Kirubakaran, Alexandra E. Stacy, Darren M. Roberts, Jonathan Brett, Stephanie E. Reuter, Richard O. Day, Jane E. Carland, Andrea L Schaffer, Jennifer J. Yang, Catriona F.J. Shen |
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| Přispěvatelé: | Stocker, Sophie L, Carland, Jane E, Reuter, Stephanie E, Stacy, Alexandra E, Schaffer, Andrea L, Stefani, Maurizio, Lau, Cindy, Kirubakaran, Ranita, Yang, Jennifer J, Shen, Catriona FJ, Roberts, Darren M, Marriott, Deborah JE, Day, Richard O, Brett, Jonathan |
| Rok vydání: | 2020 |
| Předmět: |
Adult
Male medicine.medical_specialty therapeutic drug monitoring vancomycin target attainment Pilot Projects Microbial Sensitivity Tests 030226 pharmacology & pharmacy Interrupted Time Series Analysis 03 medical and health sciences 0302 clinical medicine Pharmacokinetics Vancomycin medicine Humans Pharmacology (medical) Dosing interrupted time series Precision Medicine implementation health services Retrospective Studies Pharmacology Service (business) medicine.diagnostic_test business.industry Australia precision dosing Bayes Theorem Middle Aged Anti-Bacterial Agents Therapeutic drug monitoring 030220 oncology & carcinogenesis Pharmacodynamics Area Under Curve Emergency medicine Cohort Female Drug Monitoring business medicine.drug |
| Zdroj: | Clinical pharmacology and therapeutics. 109(1) |
| ISSN: | 1532-6535 |
| Popis: | This study evaluated the ability of a pilot therapeutic drug monitoring (TDM) Advisory Service to facilitate vancomycin therapeutic target attainment within a real-world clinical setting. The Service provided area under the concentration-time curve (AUC)-guided vancomycin dose recommendations, using Bayesian forecasting software and clinical expertise, to prescribers at an Australian hospital. A retrospective audit of intravenous vancomycin therapy (> 48 hours) in adults (≥ 18 years old) was undertaken over a 54-month period to evaluate attainment of established vancomycin pharmacokinetic/pharmacodynamic targets (AUC over 24 hours / minimum inhibitory concentration: 400-600) before (36-month period) and after (18-month period) Service implementation. Interrupted time series analysis was employed to evaluate monthly measures of the median proportion of therapy spent within the target range. Indices of time to target attainment were also assessed before and after Service implementation. The final cohort comprised 1,142 courses of vancomycin (816 patients); 835 courses (596 patients) and 307 courses (220 patients) administered before and after Service implementation, respectively. Prior to piloting the Service, the median proportion of time in the target range was 40.1% (95% CI, 34.3-46.0%); this increased by 10.4% (95% CI, 1.2-19.6%, P = 0.03) after the Service, and was sustained throughout the post-Service evaluation period. Post-Service target attainment at 48-72 hours after initiation of therapy was increased (7.8%, 95% CI, 1.3-14.3%, P = 0.02). The findings of this study provide evidence that a consultative TDM Service can facilitate attainment of vancomycin therapeutic targets; however, optimization of the Service may further improve the use of vancomycin. |
| Databáze: | OpenAIRE |
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