Benefits of therapeutic drug monitoring of vancomycin: a systematic review and meta-analysis

• Published in: PloS one 2013-10, Vol.8 (10), p.e77169
• Main Authors: Ye, Zhi-Kang, Tang, Hui-Lin, Zhai, Suo-Di
• Format: Article
• Language: English
• Subjects: Anti-Bacterial Agents - therapeutic use; Antibiotics; Bias; Clinical outcomes; Cohort analysis; Comparative analysis; Confidence intervals; Databases, Bibliographic; Drug dosages; Drug Monitoring - statistics & numerical data; Drug stores; Effectiveness; Female; Finite element method; Gram-Positive Bacteria - drug effects; Gram-Positive Bacteria - physiology; Gram-Positive Bacterial Infections - drug therapy; Gram-Positive Bacterial Infections - microbiology; Gram-Positive Bacterial Infections - mortality; Health aspects; Hospitals; Humans; Infectious diseases; Length of Stay; Male; Meta-analysis; Monitoring; Mortality; Nephrotic Syndrome - chemically induced; Nephrotic Syndrome - pathology; Odds Ratio; Online databases; Patients; Pharmacists; Population; Randomization; Randomized Controlled Trials as Topic; Staphylococcus aureus; Staphylococcus infections; Studies; Survival Analysis; Systematic review; Therapeutic drug monitoring; Therapy; Treatment Outcome; Vancomycin; Vancomycin - therapeutic use
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0077169

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. 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. 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