Crist K D, Nahata M C, Ety J
Bethesda Hospital, Zanesville, OH 43701.
Ther Drug Monit. 1987 Sep;9(3):306-10. doi: 10.1097/00007691-198709000-00010.
A prospective evaluation was undertaken to assess the impact of an aminoglycoside therapeutic drug-monitoring (TDM) program on the total dose of aminoglycoside antibiotics, the duration of therapy, the number of serum concentrations determined, the length of hospital stay, and the potential cost reduction in 221 patients with proven or suspected gram-negative infections. The patients were allocated to a group that received individualized aminoglycoside doses (study) or to a group that did not (control). The mean total dose of gentamicin or tobramycin per patient course of therapy was 1,258 mg in the study group and 1,981 mg in the control group (p less than 0.0001). The mean duration of therapy was 5.9 and 10.3 days per patient in the study and control group, respectively (p less than 0.0001). The mean length of hospital stay was 8.4 days in the study group and 11.8 days for the control (p less than 0.005). The type and site of infection, number of serum concentration determinations, and mortality were not statistically different for the groups. These data indicate that a TDM program can markedly reduce the total dose of aminoglycoside, which can potentially reduce tissue accumulation and toxicity. In addition, the hospital costs were $725 less per patient in the study group, which would produce a savings of approximately $640,000 per year at our institution.
开展了一项前瞻性评估，以评估氨基糖苷类治疗药物监测（TDM）计划对221例已证实或疑似革兰氏阴性菌感染患者的氨基糖苷类抗生素总剂量、治疗持续时间、测定的血清浓度数量、住院时间以及潜在成本降低的影响。患者被分为接受个体化氨基糖苷类剂量的组（研究组）和未接受的组（对照组）。研究组每位患者疗程中庆大霉素或妥布霉素的平均总剂量为1258毫克，对照组为1981毫克（p<0.0001）。研究组和对照组每位患者的平均治疗持续时间分别为5.9天和10.3天（p<0.0001）。研究组的平均住院时间为8.4天，对照组为11.8天（p<0.005）。两组的感染类型和部位、血清浓度测定次数以及死亡率在统计学上无差异。这些数据表明，TDM计划可显著降低氨基糖苷类的总剂量，这可能会减少组织蓄积和毒性。此外，研究组每位患者的住院费用比对照组少725美元，在我们机构每年可节省约64万美元。
