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CPC-139 Therapeutic Drug Monitoring For Glycopeptides and Aminoglycosides: Actual Situation and Perspectives in a French University Hospital
  1. LA Arnoux1,
  2. E Boschetti1,
  3. S Bevilacqua2,
  4. I May1,
  5. B Demore1
  1. 1Hopital Brabois Chu de Nancy, Pharmacie Brabois, Vandoeuvre Les Nancy, France;
  2. 2Hopital Brabois Chu de NANCY, Service des Maladies Infectieuses et Tropicales, Vandoeuvre Les Nancy, France

Abstract

Background Optimising glycopeptide and aminoglycoside treatment with Therapeutic Drug Monitoring is recommended. Under-dosing can lead to resistance and ineffective treatment while over-dosing is associated with toxicity.

Purpose To evaluate current practise by monitoring aminoglycosides and glycopeptides in a French university hospital: levels (trough and peak concentrations) and percentage of optimal concentrations based on our internal antibiotics guide.

Materials and Methods Prescriptions for glycopeptides and/or aminoglycosides, of which at least one dose had been given, were reviewed over one month (February–March 2012). Our data pool contained: patient characteristics, infection and antibiotic treatment background, serum concentration.

Results A wide range of official optimal target serum concentrations has been recommended (Consensus Review of the American Society of Health-System Pharmacists, French Pharmacology and Therapeutic Society, internal guidelines, etc.)

91 prescriptions (31 aminoglycosides, 60 glycopeptides) were analysed: the largest percentage was represented by vancomycin (55%) 80% of which were for continuous infusion. Serum vancomycin concentrations are optimised by using continuous regimens (Table 1).

For the two regimens, (continuous and intermittent, 10% of trough vancomycin serum concentrations were below 10 mg/L, exposing the patient to to subtherapeutic doses and a higher risk of selecting resistant microorganisms.

10 prescriptions for teicoplanin were reviewed: 70% of serum concentrations were below 20 mg/L and 30% below 10 mg/L.

50% of aminoglycosides trough concentrations were below the internal guideline values and target peak concentrations were not reached (amikacin: 67% under 60 mg/L, gentamycin: 90% under 30 mg/L).

Conclusions Most aminoglycosides and glycopeptides concentrations didn’t reach required therapeutic levels during this study. Consensus guidelines should be proposed to avoid bacterial resistance and guide clinical practise.

View this table:
Abstract CPC-139 Table 1

Serum vancomycin concentrations vary with the infusion regimens

No conflict of interest.

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