Pea Federico, Cojutti Piergiorgio, Dose Lucia, Baraldo Massimo
Institute of Clinical Pharmacology, Azienda Ospedaliero-Universitaria Santa Maria Della Misericordia, Udine.
Department of Experimental and Clinical Medical Sciences, University of Udine, Udine, Italy.
Br J Clin Pharmacol. 2016 Feb;81(2):341-8. doi: 10.1111/bcp.12806. Epub 2015 Dec 5.
This study explored the clinical and economic impact of clinical pharmacological advice (CPA) (based on therapeutic drug monitoring [TDM] results, and on patients' characteristics and co-medications) on personalized linezolid therapy in a tertiary care hospital.
A 1 year retrospective analysis of quality indicators of CPA (clinicians' adherence rate to CPA, pre-post rate of linezolid trough concentrations within the desired range and cost balance analysis) was conducted.
Five hundred and forty-four CPAs were provided to clinicians during 2014 for personalizing linezolid therapy in 168 patients. Clinicians' adherence to CPAs was very high (94.7%). The pre-post rate of linezolid Cmin distribution showed a favourable impact of CPA on patient care (pre-post ratio of Cmin within the desired range + 23.4%, pre, 51.2% vs. post, 74.6%). Overall, linezolid dosage was mainly reduced (56.9% of cases), whereas dose augmentation was needed only in a minority of cases (7.7%). Cost balance analysis showed that overall 1258 standard doses of linezolid (unitary dose 600 mg) were spared for treating 168 patients with a personalized dosage for a median duration of 11 days (range 3-128 days) with a cost saving of 60038.05 €.
Active computerized advice elaborated by the clinical pharmacologist on the basis of TDM results and of patient's pathophysiological data and co-medications may be cost-effective for personalizing linezolid treatment.
本研究探讨了临床药理学建议（CPA）（基于治疗药物监测[TDM]结果、患者特征和合并用药情况）对三级医院利奈唑胺个体化治疗的临床和经济影响。
对CPA的质量指标进行了为期1年的回顾性分析（临床医生对CPA的依从率、利奈唑胺谷浓度在期望范围内的前后变化率以及成本平衡分析）。
2014年期间，向临床医生提供了544条CPA，用于168例患者的利奈唑胺个体化治疗。临床医生对CPA的依从性非常高（94.7%）。利奈唑胺Cmin分布的前后变化率显示CPA对患者护理有积极影响（Cmin在期望范围内的前后变化率为+23.4%，之前为51.2%，之后为74.6%）。总体而言，利奈唑胺剂量主要降低（56.9%的病例），而仅在少数病例中需要增加剂量（7.7%）。成本平衡分析表明，在为168例患者进行中位疗程为11天（范围3 - 128天）的个体化给药治疗时，总共节省了1258个利奈唑胺标准剂量（单位剂量600 mg），节省成本60038.05欧元。
临床药理学家根据TDM结果、患者病理生理数据和合并用药情况精心制定的主动计算机化建议，可能对利奈唑胺个体化治疗具有成本效益。
