Benefits of Therapeutic Drug Monitoring of Vancomycin: A Systematic Review and Meta-AnalysisReport as inadecuate




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Background and Objective

The necessity of therapeutic drug monitoring TDM for vancomycin is controversial. The objective of the current review was to evaluate the available evidence for the necessity of TDM in patients given vancomycin to treat Gram-positive infections.

Methods

Medline, Embase, Web of Sciences, the Cochrane Library and two Chinese literature databases CNKI, CBM were searched. Randomized controlled studies and observational studies that compared the clinical outcomes of TDM groups vs. non-TDM groups were included. Two reviewers independently extracted the data. The primary outcome was clinical efficacy of therapy. Secondary outcomes included vancomycin associated nephrotoxicity, duration of vancomycin therapy, length of hospital stay, and mortality. Meta-analysis was performed using the Mantel-Haenszel fixed effect method FEM. Odds ratios ORs or weighted mean differences WMD with 95% confidence intervals 95%CIs were calculated for categorical and continuous outcomes, respectively.

Results

One randomized controlled trial RCT and five cohort studies were included in the meta-analysis. Compared with non-TDM groups, TDM groups had significantly higher rates of clinical efficacy OR = 2.62, 95%CI 1.34–5.11 P = 0.005 and decreased rates of nephrotoxicity OR = 0.25, 95%CI 0.13–0.48 P<0.0001. Subgroup analyses showed that TDM group had significantly higher rates of clinical efficacy in both cohort studies subgroup OR = 3.04, 95%CI 1.34–6.90 and in Asian population subgroup OR = 3.04, 95%CI 1.34–6.90. TDM group had significantly decreased rates of nephrotoxicity in all subgroup. There was no significant difference in duration of vancomycin therapy WMD = −0.40, 95%CI −2.83–2.02 P = 0.74 or length of stay WMD = −1.01, 95%CI −7.51-5.49 P = 0.76 between TDM and non-TDM groups. Subgroup analyses showed there were no differences in duration of vancomycin therapy. Only one study reported mortality rates.

Conclusions

Studies to date show that TDM significantly increases the rate of clinical efficacy and decreases the rate of nephrotoxicity in patients treated with vancomycin.



Author: Zhi-Kang Ye, Hui-Lin Tang, Suo-Di Zhai

Source: http://plos.srce.hr/



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