title: Clinical pharmacist impact on care, length of stay, and cost in pediatric cystic fibrosis (CF) patients.
abstract: BACKGROUND
  Cystic fibrosis (CF) patients are often treated with aminoglycoside (AG) antibiotics during infective pulmonary exacerbations. Achieving pharmacokinetic and pharmacodynamic (PK/PD) targets to improve outcomes and counteract resistance is paramount.
  
  
  OBJECTIVE
  The primary objective was to compare the number of pediatric CF patients achieving AG PK/PD targets when a clinical pharmacist (CP) managed therapeutic drug monitoring (TDM) compared with usual care (UC).
  
  
  METHODS
  A retrospective cohort study was conducted on the records of 40 CF patients that received AGs and ≥2 serum samples between 1/2007 and 5/2009. Chi-square and Student's t-test were used to analyze nominal and continuous variables, respectively.
  
  
  RESULTS
  Twenty-nine patients with 52 courses of AGs were included the CP group, and 22 patients with 42 courses were included the UC group. Ninety-eight percent of patients in the CP group reached AG PK/PD targets compared with 71% in the UC group, P < 0.001. Patients in the CP group reached the AG PK/PD target in a mean of 1.9 ± 0.8 days compared with 4.8 ± 3.4 days in the UC group, P < 0.0001. The average LOS in the CP group was 9 ± 5 days compared with 12 ± 7.5 days in the UC group, P = 0.033. The mean number of levels per patient was 2.7 in the CP group compared with 5.2 (range of 2-20) in the UC group, P < 0.001. Resource utilization associated with drug levels, dosing adjustments and LOS were $26,549, $14,069, and $1,680,000 in the CP group as compared with $40,683, $27,812, and $1,940,000, respectively, in the UC group.
  
  
  CONCLUSIONS
  CP managed TDM resulted in a significantly higher percentage of pediatric CF patients achieving AG PK/PD targets 3 days sooner with an average LOS that was 3 days shorter. CP managed TDM resulted in significantly fewer dosage adjustments, drug levels, and cost associated with serum sampling, drug wastage, and LOS.
authors.affiliation: St. Christopher's Hospital for Children, Philadelphia, Pennsylvania; Drexel University College of Medicine, Philadelphia, Pennsylvania.
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Cies
authors.forename: Laurie
authors.initials: L
authors.lastname: Varlotta
mesh_terms: D000293:Adolescent; D000617:Aminoglycosides / Q000627:therapeutic use*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003550:Cystic Fibrosis / Q000150:complications / Q000188:drug therapy*; D018450:Disease Progression; D016903:Drug Monitoring / Q000191:economics / Q000379:methods*; D005260:Female; D017721:Hospital Costs; D006801:Humans; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data; D008297:Male; D010607:Pharmacy Service, Hospital / Q000191:economics / Q000379:methods*; D011552:Pseudomonas Infections / Q000150:complications / Q000188:drug therapy*; D012141:Respiratory Tract Infections / Q000150:complications / Q000188:drug therapy*; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D000617:Aminoglycosides; D000900:Anti-Bacterial Agents
keywords: aminoglycosides; cystic fibrosis; pediatric; pharmacokinetics; therapeutic drug monitoring