Alhameed Abrar F, Khansa Sara Al, Hasan Hani, Ismail Sherine, Aseeri Mohammed
King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences, 21423 Jeddah, Saudi Arabia.
Pharmaceutical Care Services, Prince Mohammed Bin Abdulaziz Hospital, MNGHA, 42221 Madinah, Saudi Arabia.
Pharmacy (Basel). 2019 Feb 18;7(1):20. doi: 10.3390/pharmacy7010020.
Many hospitals face barriers in the implementation of TDM services, this study aimed to evaluate a pharmacist-led TDM service to optimize patients' outcomes. Adult patients who were administered vancomycin, gentamicin, or amikacin were included. The pre-phase included a retrospective assessment of patients and the intervention phase consisted of an educational program. The post-phase assessed patients based on TDM services provided by inpatient pharmacists on a 24-h, 7-day basis for 3 months. The primary outcome was to assess the mean difference in proportion of correct initial doses of prescribing orders. Secondary outcomes included assessing the mean differences in proportions of correct dose adjustments and correct drug sampling time. Seventy-five patients in each phase were eligible. Patients who received optimal initial dosing in the post-phase showed a higher statistical significance, mean difference of 0.31, [95% CI (0.181⁻0.4438), < 0.0001]. Patients in the post-phase received more optimal dose adjustments, mean difference of 0.1, [95% CI (-0.560⁻0.260), = 0.2113]. Drug levels were ordered more correctly in the post-phase, mean difference of 0.03, [95% CI (-0.129⁻0.189), = 0.7110]. This study demonstrated the important role of TDM services led by pharmacists in optimizing the initial dosing for these antibiotics.
许多医院在实施治疗药物监测（TDM）服务方面面临障碍，本研究旨在评估由药剂师主导的TDM服务，以优化患者的治疗效果。纳入了接受万古霉素、庆大霉素或阿米卡星治疗的成年患者。前期包括对患者的回顾性评估，干预阶段包括一个教育项目。后期基于住院药剂师提供的24小时、每周7天、为期3个月的TDM服务对患者进行评估。主要结局是评估处方医嘱初始正确剂量比例的平均差异。次要结局包括评估正确剂量调整比例和正确药物采样时间的平均差异。每个阶段有75名患者符合条件。后期接受最佳初始给药的患者具有更高的统计学显著性，平均差异为0.31，[95%置信区间（0.181⁻0.4438），<0.0001]。后期患者接受了更多的最佳剂量调整，平均差异为0.1，[95%置信区间（-0.560⁻0.260），=0.2113]。后期药物水平的医嘱更正确，平均差异为0.03，[95%置信区间（-0.129⁻0.
