In Chugoku-Rosai General Hospital,doctors have notified the department of pharmacy of the use of anti-MRSA antibiotics beforehand since June 2005,and pharmacists have actively intervened in the determination of initial dosages of teicoplanin (TEIC).In the present study,we evaluated the effectiveness of pharmacist intervention by comparing the initial dosage,days of administration,plasma concentrations,and the clinical effect of TEIC treatment between before and after intervention by pharmacists began.The relationships between the initial dosage and plasma TEIC concentrations and between plasma TEIC concentrations and clinical efficacy were also evaluated.The following findings were obtained : 1)higher unbound plasma concentrations of TEIC did not always result in greater clinical efficacy ; 2)higher trough concentrations of TEIC resulted in greater clinical efficacy ; 3)trough TEIC concentrations of more than 20μg/mL caused hepatic damage,as evaluated by plasma AST and ALT activities and 4)higher initial TEIC dosages resulted in higher TEIC plasma concentrations in the early stage,shortening treatment periods as compared with before pharmacist intervention started,and severe renal dysfunction was avoided.
In conclusion,active intervention by pharmacists in determining optimal dosages was considered effective in improving pharmacotherapy with TEIC.
