The Impact of Pharmacist Involvement in Therapeutic Drug Monitoring on Clinical Outcomes
DOI:
https://doi.org/10.22399/ijcesen.4674Keywords:
Clinical Pharmacist, Therapeutic Drug Monitoring (TDM), clinical outcomes, Pharmacokinetics, Personalized Dosing, Narrow Therapeutic IndexAbstract
The integration of pharmacists into the Therapeutic Drug Monitoring (TDM) process has a profoundly positive impact on clinical outcomes, transforming it from a reactive laboratory test into a proactive, patient-centric management strategy. By applying specialized expertise in pharmacokinetics and pharmacotherapy, pharmacists ensure accurate interpretation of drug levels within the full clinical context—considering factors like timing, organ function, and drug interactions. This leads to precise, individualized dosing recommendations for medications with a narrow therapeutic index, such as aminoglycosides, vancomycin, and immunosuppressants. The direct clinical results are measurably improved: enhanced therapeutic efficacy, a significant reduction in drug-related toxicity and adverse events, and improved patient adherence through education. Furthermore, pharmacist-led TDM fosters stronger interdisciplinary collaboration and generates substantial healthcare system benefits by preventing costly complications, optimizing resource use, and shortening hospital stays, thereby elevating the overall quality, safety, and efficiency of patient care.
References
[1] Kanda Y. Investigation of the freely available easy-to-use software EZR for medical statistics. Bone Marrow Transpl. 2013;48:452–8.
[2] Houot M, Pilmis B, Thepot-Seegers V, Suard C, Potier C, Postaire M, et al. Aminoglycoside use in a pediatric hospital: there is room for improvement-a before/after study. Eur J Pediatr. 2016;175:659–65.
[3] Yamada T, Fujii S, Shigemi A, Takesue Y. A meta-analysis of the target trough concentration of gentamicin and amikacin for reducing the risk of nephrotoxicity. J Infect Chemother. 2021;26:256–61.
[4] Barlam TF, Cosgrove SE, Abbo LM, MacDougall C, Schuetz AN, Septimus EJ, et al. Implementing an antibiotic stewardship program: guidelines by the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America. Clin Infect Dis. 2016;62:e51–77.
[5] Mesaros N, Nordmann P, Plésiat P, Roussel-Delvallez M, Van Eldere J, Glupczynski Y, et al. Pseudomonas aeruginosa: resistance and therapeutic options at the turn of the new millennium. Clin Microbiol Infect. 2007;13:560–78.
[6] Nakatani S, Ohara T, Ashihara K, Izumi C, Iwanaga S, Eishi K, et al. JCS 2017 guideline on prevention and treatment of infective endocarditis. Circ J. 2019;83:1767–809.
[7] Tamma PD, Aitken SL, Bonomo RA, Mathers AJ, van Duin D, Clancy CJ. Infectious Diseases Society of America 2023 guidance on the treatment of antimicrobial resistant gram-negative infections. Clin Infect Dis Infect Dis Soc Am. 2023;ciad428.
[8] Pitiriga V, Dimitroulia E, Saroglou G, Tsakris A. The challenge of curbing aminoglycoside resistance: can antimicrobial stewardship programs play a critical role? Expert Rev Anti Infect Ther. 2017;15:947–54.
[9] Freifeld AG, Bow EJ, Sepkowitz KA, Boeckh MJ, Ito JI, Mullen CA, et al. Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 update by the Infectious Diseases Society of America. Clin Infect Dis. 2011;52:e56–93.
[10] Roger C, Louart B, Elotmani L, Barton G, Escobar L, Koulenti D, et al. An international survey on aminoglycoside practices in critically ill patients: the AMINO III study. Ann Intensive Care. 2021;11:49.
[11] Imani S, Alffenaar JW, Cotta MO, Daveson K, van Hal S, Lau C, et al. Therapeutic drug monitoring of commonly used anti-infective agents: a nationwide cross-sectional survey of Australian hospital practices. Int J Antimicrob Agents. 2020;56:106180.
[12] Picard W, Bazin F, Clouzeau B, Bui HN, Soulat M, Guilhon E, et al. Propensity-based study of aminoglycoside nephrotoxicity in patients with severe sepsis or septic shock. Antimicrob Agents Chemother. 2014;58:7468–74.
[13] Delgado V, Ajmone Marsan N, De Waha S, Bonaros N, Brida M, Burri H, et al. 2023 ESC guidelines for the management of endocarditis. Eur Heart J. 2023;44:3948–4042.
[14] Nauriyal V, Rai SM, Joshi RD, Thapa BB, Kaljee L, Prentiss T, et al. Evaluation of an antimicrobial stewardship program for wound and burn care in three hospitals in Nepal. Antibiot (Basel). 2020;9:914.
[15] Sandaradura I, Alffenaar JW, Cotta MO, Daveson K, Day RO, Van Hal S, et al. Emerging therapeutic drug monitoring of anti-infective agents in Australian hospitals: availability, performance and barriers to implementation. Br J Clin Pharmacol. 2022;88:669–79.
[16] Cook PP, Gooch M. Long-term effects of an antimicrobial stewardship programme at a tertiary-care teaching hospital. Int J Antimicrob Agents. 2015;45:262–7.
[17] Buckman SA, Forrester JD, Bessoff KE, Parli SE, Evans HL, Huston JM. Surgical Infection Society Guidelines: 2022 updated guidelines for antibiotic use in open extremity fractures. Surg Infect (Larchmt). 2022;23:817–28.
[18] Mermel LA, Allon M, Bouza E, Craven DE, Flynn P, O’Grady NP, et al. Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 update by the Infectious Diseases Society of America. Clin Infect Dis. 2009;49:1–45.
[19] Khwaja A. KDIGO clinical practice guidelines for acute kidney injury. Nephron Clin Pract. 2012;120:c179–84.
[20] Martinez-Salgado C, López-Hernández FJ, López-Novoa JM. Glomerular nephrotoxicity of aminoglycosides. Toxicol Appl Pharmacol. 2007;223:86–98.
[21] Huang X, Liu YX, Lao JH, Cao J, Li X, Yao WB. The incidence of acute kidney injury in hospitalised patients receiving aminoglycoside antibiotics: a retrospective study. Eur Rev Med Pharmacol Sci. 2022;26:3718–25.
[22] Katagiri H, Mitsuboshi S, Katagiri H, Tsugita M. Antimicrobial therapeutic drug monitoring performance rate in Niigata: evaluation between performance rate and relevant factors. Japanese J Environ Infections. 2018;33:62–6.
[23] Rybak MJ, Abate BJ, Kang SL, Ruffing MJ, Lerner SA, Drusano GL. Prospective evaluation of the effect of an aminoglycoside dosing regimen on rates of observed nephrotoxicity and ototoxicity. Antimicrob Agents Chemother. 1999;43:1549–55.
[24] McWilliam SJ, Antoine DJ, Smyth RL, Pirmohamed M. Aminoglycoside-induced nephrotoxicity in children. Pediatr Nephrol. 2017;32:2015–25.
[25] Jenkins A, Thomson AH, Brown NM, Semple Y, Sluman C, MacGowan A, et al. Amikacin use and therapeutic drug monitoring in adults: do dose regimens and drug exposures affect either outcome or adverse events? A systematic review. J Antimicrob Chemother. 2016;71:2754–9.
[26] Nezic L, Derungs A, Bruggisser M, Tschudin-Sutter S, Krähenbühl S, Haschke M. Therapeutic drug monitoring of once daily aminoglycoside dosing: comparison of two methods and investigation of the optimal blood sampling strategy. Eur J Clin Pharmacol. 2014;70:829–37.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2024 International Journal of Computational and Experimental Science and Engineering

This work is licensed under a Creative Commons Attribution 4.0 International License.