Practices associated with serum antiepileptic drug level monitoring at a pediatric neurology clinic: a Malaysian experience.
OBJECTIVE
To assess the practices associated with the application of therapeutic drug monitoring (TDM) for antiepileptic drugs (AEDs) in the management of children with structural-metabolic epilepsy.


METHODS
It was a retrospective chart review and included children aged ≥2 years old with structural-metabolic epilepsy, treated with AEDs, and received TDM. The data were extracted from the medical records.


RESULTS
Thirty-two patients were identified with 50 TDM assays. In two thirds of the assays, "check level" and "recheck level" were the reasons behind the requesting of serum level monitoring of AEDs. Knowledge of serum AED levels led to alterations in the management in 60% of the assays. Thirty-two (76%) pediatrician's actions were consistent with the recommendation of TDM pharmacist. Forty-nine (98%) levels were appropriately indicated. In relation to the appropriateness of sampling time, 9 (18%) levels were not assessed due to missing data. Twenty-seven (54%) levels were appropriately sampled.


CONCLUSIONS
More studies should be designed to improve the component of the current TDM request form, especially in the reason section. By the same token, the number of pointless assays and the costs to the health care system can be reduced both by enhancing and improving the educational standards of the requesting neurologists.
College of Pharmacy, Al-Rashed University, Baghdad, Iraq. muhanad_rmk@yahoo.com
Muhannad R M
MR
Salih
Mohd Baidi
MB
Bahari
Mohamed Azmi Ahmad
MA
Hassali
Asrul Akmal
AA
Shafie
Omer Qutaiba B
OQ
Al-Lela
Arwa Y
AY
Abd
Vigneswari
V
Ganesan
D000293:Adolescent; D000927:Anticonvulsants / Q000008:administration & dosage / Q000097:blood* / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D016903:Drug Monitoring / Q000379:methods*; D004827:Epilepsy / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008296:Malaysia; D008297:Male; D010593:Pharmaceutical Services / Q000458:organization & administration; D010595:Pharmacists / Q000458:organization & administration; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013997:Time Factors
D000927:Anticonvulsants