The relevance of a First-World therapeutic drug monitoring service to the treatment of epilepsy in Third-World conditions.
In May 1988 a Therapeutic Drug Monitoring (TDM) service for anti-epileptic drugs was established at Prince Mshiyeni Memorial Hospital. This service was offered as a multidisciplinary team approach involving sisters, doctors, social workers and pharmacists at an epilepsy clinic. Statistics gathered over a 13-month period showed that: (i) epileptic patient numbers increased from 52 to 211 per 4-week cycle, while patients requiring TDM decreased from 40 to 20 per cycle; (ii) phenytoin was the most frequently prescribed anticonvulsant, followed by carbamazepine and phenobarbitone, throughout the period; (iii) TDM did not alter prescribing patterns--approximately 90% of patients were on monotherapy at the beginning and at the end of the assessment period; (iv) 471 serum levels were measured in 280 patients over 13 months. Phenytoin serum levels constituted the majority (53%) followed by carbamazepine (33%), phenobarbitone (12%) and valproate (2%); (v) of the levels measured in 24 patients taking phenytoin 300 mg/d who were experiencing neither seizures nor side-effects, 38% of levels were in the potentially toxic range; and (vi) well-controlled patients increased from 36% in the first cycle to 60% in the last cycle. A TDM service is very useful in a Third-World setting and can assist in conserving scarce sources provided it is utilised within a holistic treatment framework.
McFadyen
M L
ML
Department of Pharmacology, University of Durban-Westville.
Miller
R
R
Juta
M
M
Hodgson
V
V
D000293:Adolescent; D000328:Adult; D000927:Anticonvulsants / Q000008:administration & dosage / Q000097:blood*; D002648:Child; D003906:Developing Countries; D004827:Epilepsy / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008297:Male; D008991:Monitoring, Physiologic; D010044:Outpatient Clinics, Hospital; D013019:South Africa; D013997:Time Factors
D000927:Anticonvulsants