Na He1,2, Shan Su1,2, Zhikang Ye3, Guanhua Du4, Bei He5, Dakui Li6, Youning Liu7, Kehu Yang8,9, Xianglin Zhang10, Yingyuan Zhang11, Xiao Chen12, Yaolong Chen8,9, Zhigang Chen13, Yalin Dong14, Guang Du15, Jian Gu16, Daihong Guo17, Ruichen Guo18, Xin Hu19, Zheng Jiao20, Huande Li21, Gaolin Liu22, Zhiping Li23, Yuan Lv24, Wei Lu2, Liyan Miao25, Jieming Qu26, Tieying Sun27, Rongsheng Tong28, Li Wang29, Minggui Wang11, Rui Wang30, Aidong Wen31, Jiuhong Wu32, Xin'an Wu33, Yingchun Xu34, Yong Yang28, Fan Yang11, Siyan Zhan35, Bikui Zhang21, Chao Zhang36, Huizhi Zhang37, Jie Zhang38, Jing Zhang11, Jun Zhang39, Wenting Zhang15, Libo Zhao40, Limei Zhao41, Rongsheng Zhao1, Wei Zhao42, Zhigang Zhao43, Wei Zhou44, Xian-Tao Zeng45, Suodi Zhai1. 1. Department of Pharmacy, Peking University Third Hospital, Beijing, China. 2. School of Pharmaceutical Science, Peking University, Beijing, China. 3. Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada. 4. Institute of Materia Medica, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China. 5. Department of Respiratory Medicine, Peking University Third Hospital, Beijing, China. 6. Department of Pharmacy, Peking Union Medical College Hospital, Beijing, China. 7. Department of Respiratory and Critical Care Medicine, Chinese People's Liberation Army General Hospital, Beijing, China. 8. Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China. 9. Chinese GRADE Center, Lanzhou, China. 10. Department of Pharmacy, China-Japan Friendship Hospital, Beijing, China. 11. Institute of Antibiotics, Huashan Hospital affiliated with Fudan University, Shanghai, China. 12. Department of Pharmacy, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China. 13. Clinical Trial Center of Beijing Jishuitan Hospital, Beijing, China. 14. Department of Pharmacy, First Affiliated Hospital of Xi'an Jiao Tong University, Xi'an, China. 15. Department of Pharmacy, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China. 16. Department of Pharmacy, Peking University People's Hospital, Beijing, China. 17. Drug Security Center, Chinese People's Liberation Army General Hospital, Beijing, China. 18. Institute of Clinical Pharmacology, Qilu Hospital of Shandong University, Jinan, China. 19. Department of Pharmacy, Beijing Hospital, Beijing, China. 20. Department of Pharmacy, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China. 21. Department of Pharmacy, Second Xiangya Hospital, Central South University, Changsha, China. 22. Department of Pharmacy, Shanghai First People's Hospital, Shanghai, China. 23. Department of Pharmacy, National Children's Medical Center/Children's Hospital of Fudan University, Shanghai, China. 24. Institute of Clinical Pharmacology, Peking University First Hospital, Beijing, China. 25. Department of Pharmacy, First Affiliated Hospital of Soochow University, Suzhou, China. 26. Department of Respiratory and Critical Care Medicine, Ruijin Hospital affiliated with Shanghai Jiao Tong University School of Medicine, Shanghai, China. 27. Department of Respiratory and Critical Care Medicine, Beijing Hospital, National Center of Gerontology, Beijing, China. 28. Department of Pharmacy, Sichuan Provincial People's Hospital, Chengdu, China. 29. Department of Pediatrics, Peking University First Hospital, Beijing, China. 30. Laboratory of Clinical Pharmacology, Chinese People's Liberation Army General Hospital, Beijing, China. 31. Department of Pharmacy, Xijing Hospital, Xi'an, China. 32. Department of Pharmacy, 306th Hospital of People's Liberation Army, Beijing, China. 33. Department of Pharmacy, Lanzhou University First Hospital, Lanzhou, China. 34. Department of Laboratory Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China. 35. Center for Clinical Epidemiology, Peking University Third Hospital, Beijing, China. 36. Department of Pharmacy, Beijing Tongren Hospital, Beijing, China. 37. Nursing Department, Peking University Third Hospital, Beijing, China. 38. Department of Laboratory Medicine, Peking University Third Hospital, Beijing, China. 39. Pharmacy Department, First Affiliated Hospital of Kunming Medical University, Kunming, China. 40. Department of Pharmacy, Beijing Children's Hospital, Capital Medical University, Beijing, China. 41. Department of Pharmacy, Shengjing Hospital of China Medical University, Shenyang, China. 42. Department of Clinical Pharmacy, School of Pharmaceutical Sciences, Cheeloo College of Medicine, Shandong University, Jinan, China. 43. Pharmacy Department, Beijing Tiantan Hospital, Beijing, China. 44. Department of Pediatrics, Peking University Third Hospital, Beijing, China. 45. Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China.
Abstract
BACKGROUND: Clinical practice guidelines or recommendations often require timely and regular updating as new evidence emerges, because this can alter the risk-benefit trade-off. The scientific process of developing and updating guidelines accompanied by adequate implementation can improve outcomes. To promote better management of patients receiving vancomycin therapy, we updated the guideline for the therapeutic drug monitoring (TDM) of vancomycin published in 2015. METHODS: Our updated recommendations complied with standards for developing trustworthy guidelines, including timeliness and rigor of the updating process, as well as the use of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. We also followed the methodology handbook published by the National Institute for Health and Clinical Excellence and the Spanish National Health System. RESULTS: We partially updated the 2015 guideline. Apart from adults, the updated guideline also focuses on pediatric patients and neonates requiring intravenous vancomycin therapy. The guideline recommendations involve a broadened range of patients requiring TDM, modified index of TDM (both 24-hour area under the curve and trough concentration), addition regarding the necessity and timing of repeated TDM, and initial dose for specific subpopulations. Overall, 1 recommendation was deleted and 3 recommendations were modified. Eleven new recommendations were added, and no recommendation was made for 2 clinical questions. CONCLUSIONS: We updated an evidence-based guideline regarding the TDM of vancomycin using a rigorous and multidisciplinary approach. The updated guideline provides more comprehensive recommendations to inform rational and optimized vancomycin use and is thus of greater applicability.
BACKGROUND: Clinical practice guidelines or recommendations often require timely and regular updating as new evidence emerges, because this can alter the risk-benefit trade-off. The scientific process of developing and updating guidelines accompanied by adequate implementation can improve outcomes. To promote better management of patients receiving vancomycin therapy, we updated the guideline for the therapeutic drug monitoring (TDM) of vancomycin published in 2015. METHODS: Our updated recommendations complied with standards for developing trustworthy guidelines, including timeliness and rigor of the updating process, as well as the use of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. We also followed the methodology handbook published by the National Institute for Health and Clinical Excellence and the Spanish National Health System. RESULTS: We partially updated the 2015 guideline. Apart from adults, the updated guideline also focuses on pediatric patients and neonates requiring intravenous vancomycin therapy. The guideline recommendations involve a broadened range of patients requiring TDM, modified index of TDM (both 24-hour area under the curve and trough concentration), addition regarding the necessity and timing of repeated TDM, and initial dose for specific subpopulations. Overall, 1 recommendation was deleted and 3 recommendations were modified. Eleven new recommendations were added, and no recommendation was made for 2 clinical questions. CONCLUSIONS: We updated an evidence-based guideline regarding the TDM of vancomycin using a rigorous and multidisciplinary approach. The updated guideline provides more comprehensive recommendations to inform rational and optimized vancomycin use and is thus of greater applicability.
Authors: Barbara Schmidt; Ralf Wagner; David Peterhoff; Vivian Glück; Matthias Vogel; Philipp Schuster; Anja Schütz; Philip Neubert; Veruschka Albert; Stefanie Frisch; Mara Kiessling; Philip Pervan; Maren Werner; Nicole Ritter; Leon Babl; Maria Deichner; Frank Hanses; Matthias Lubnow; Thomas Müller; Dirk Lunz; Florian Hitzenbichler; Franz Audebert; Viola Hähnel; Robert Offner; Martina Müller; Stephan Schmid; Ralph Burkhardt; Thomas Glück; Michael Koller; Hans Helmut Niller; Bernhard Graf; Bernd Salzberger; Jürgen J Wenzel; Jonathan Jantsch; André Gessner Journal: Infection Date: 2020-08-21 Impact factor: 7.455