Therapeutic Drug Monitoring of Anti-infective Drugs: Implementation Strategies for 3 Different Scenarios

被引:12
作者
Kim, Hannah Yejin [1 ,2 ,3 ]
Byashalira, Kenneth C. [4 ]
Heysell, Scott K. [5 ]
Martson, Anne-Grete [6 ]
Mpagama, Stellah G. [4 ]
Rao, Prakruti [5 ]
Sturkenboom, Marieke G. G. [6 ]
Alffenaar, Jan-Willem C. [1 ,2 ,3 ]
机构
[1] Univ Sydney, Fac Med & Hlth, Sch Pharm, Pharm Bldg A15, Sydney, NSW 2006, Australia
[2] Univ Sydney, Westmead Hosp, Sydney, NSW, Australia
[3] Univ Sydney, Marie Bashir Inst Infect Dis, Sydney, NSW, Australia
[4] Kibongoto Infect Dis Hosp, Moshi, Tanzania
[5] Univ Virginia, Div Infect Dis & Int Hlth, Charlottesville, VA USA
[6] Univ Groningen, Univ Med Ctr Groningen, Dept Clin Pharm & Pharmacol, Groningen, Netherlands
基金
美国国家卫生研究院;
关键词
therapeutic drug monitoring; limited sampling; dosing software; saliva; DRIED BLOOD SPOTS; ANTITUBERCULOSIS DRUGS; LC-MS/MS; VANCOMYCIN; RIFAMPICIN; HIV; PHARMACOKINETICS; ANTIBIOTICS; GENTAMICIN; CHALLENGES;
D O I
10.1097/FTD.0000000000000936
中图分类号
R446 [实验室诊断]; R-33 [实验医学、医学实验];
学科分类号
1001 ;
摘要
Background: Therapeutic drug monitoring (TDM) supports personalized treatment. For successful implementation, TDM must have a turnaround time suited to the clinical needs of patients and their health care settings. Here, the authors share their views of how a TDM strategy can be tailored to specific settings and patient groups. Methods: The authors selected distinct scenarios for TDM: high-risk, complex, and/or critically ill patient population; outpatients; and settings with limited laboratory resources. In addition to the TDM scenario approach, they explored potential issues with the legal framework governing dose escalation. Results: The most important issues identified in the different scenarios are that critically ill patients require rapid turnaround time, outpatients require an easy sampling procedure for the sample matrix and sample collection times, settings with limited laboratory resources necessitate setting-specific analytic techniques, and all scenarios warrant a legal framework to capture the use of escalated dosages, ideally with the use of trackable dosing software. Conclusions: To benefit patients, TDM strategies need to be tailored to the intended population. Strategies can be adapted for rapid turnaround time for critically ill patients, convenient sampling for outpatients, and feasibility for those in settings with limited laboratory resources.
引用
收藏
页码:3 / 10
页数:8
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