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This retrospective multicenter study was performed to determine the clinical usefulness of therapeutic drug monitoring (TDM) of vancomycin hydrochloride (VCM), teicoplanin (TEIC) and arbekacin sulfate (ABK) for antimicrobial therapy. As a project of the Tottori Antimicrobial Resistance Surveillance Network, survey forms for 2,130 patients were collected from 12 medical institutions in Tottori prefectural during the period from January 2010 to December 2011. Tolerability was examined in 2,000 patients and efficacy in 1,102 patients. The incidences of tolerable side effects of VCM, TEIC and ABK were 1.7%, 2.8% and 0.7%, respectively, and these rates were not affected by the TDM implementation. The efficacy rates of VCM, TEIC and ABK were 78.1%, 79.9% and 69.4%, respectively. The efficacy rate of VCM in patients with TDM was 81.6%, which was significantly higher than that in patients without TDM (71.9%) (P = 0.0008), and a significant difference was found between those with TDM (77.7%) and without TDM (62.4%) for respiratory tract infections (P = 0.005). The efficacy rate of TEIC in patients with TDM was 85.3%, which was significantly higher than that in patients without TDM (66.7%) (P = 0.0141), and a significant difference was found between those with TDM (88.9%) and without TDM (47.4%) for respiratory tract infections (P = 0.0023). However, no significant difference was found in the efficacy rates of ABK. Our results suggest that clinical benefits of dose adjustment based on TDM for treatment of infections were only demonstrated for VCM and TEIC.

A Multicenter Study of Therapeutic Drug Monitoring and Clinical Response for Anti-Methicillin-resistant Staphylococcus Aureus Agents