Outcome of vancomycin therapeutic drug monitoring service at Srinagarind Hospital
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Abstract
Therapeutic drug monitoring (TDM) is a clinical pharmacy service that helps optimize medication dosages for individual patients. The Faculty of Pharmaceutical Sciences, Khon Kaen University, has provided vancomycin TDM services at Srinagarind Hospital since 1997. However, there is still a lack of data regarding changes in drug consumption following the implementation of this service. The objective of this study is to collect data on the outcomes of vancomycin TDM services and to compare the estimated vancomycin consumption with the actual consumption volume. Methods: This was a retrospective descriptive study conducted in inpatient subjects aged 18 years and older with stable renal function. Participants received intravenous vancomycin and vancomycin TDM services at Srinagarind Hospital during the 2025 fiscal year. Data were collected from TDM service reports, electronic databases, and patient medical records. Outcome data were analyzed, and consumption volumes were compared using descriptive and inferential statistics. Results: A total of 143 patients met the screening criteria, involving 374 TDM service instances. Drug levels were within the therapeutic range in 28.9% of cases, below the range in 30.5%, and above the range in 39.6%. Pharmacists provided recommendations to adjust the dosage in 47.6% of cases, withhold the dose in 16.6%, and maintain the current dose in 26.7%. Physicians followed these recommendations at a rate of 81.6%. This associated to a statistically significant increase in the proportion of drug levels within the therapeutic range (from 15.4% to 38.3%) and a decrease in levels outside the range (from 84.6% to 61.7%) (p-value < 0.05). Regarding consumption differences, the actual volume used was 111.47 DDD lower than the estimated consumption, representing a value of 38,766 Baht; however, this was not statistically significant (p = 0.091 and 0.125, respectively). Conclusion: Vancomycin TDM facilitated dosage adjustment, increasing the likelihood of patients reaching the therapeutic range while slightly reducing overall vancomycin consumption. Nevertheless, monitoring of peak and drug levels should be encouraged, along with follow-up on drug concentrations and clinical results after treatment.
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