Therapeutic drug monitoring survey of anti-MRSA agents in Japan

We distributed questionnaires to determine therapeutic drug monitoring(TDM) status for anti-MRSA agents vancomycin(VCM), teicoplanin(TEIC), and arbekacin(ABK) in 563 Japanese hospitals having pharmacists enrolled in the Japanese Society of Chemotherapy. Responses were collected from 302 (53.6%) institutions. In over 80% of facilities, pharmacists provide clinical consultation on anti-MRSA agents based on TDM. General recommendations for monitoring serum drugs concentrations are as follows: (1) VCM, trough concentration on day 3 targeting >10 μg/mL; (2) TEIC, on day 4 targeting >15 μg/mL; and (3) ABK, on day 3 targeting <2μg/mL and peak >9 μg/mL. Answers for main questions such as sample timing, sampling points, and targeted concentrations, were roughly equivalent to our recommendations. Standardizing TDM involves problems including large inter institutional differences in ABK TDM and no claim of rights to cost monitoring more than twice a month under the current government-run health insurance system.