Current status of antibiotic therapeutic drug monitoring and individualized medication in China

【Abstract】 Due to the unreasonable application of antibiotics in the past decades, bacterial resistance has become increasingly serious. Rational use of antibiotics has become especially important, and therapeutic drug monitoring （TDM） is a part of it. In the past 30 years, thanks to the development of detection methods, TDM and individualized medication of antibiotics have developed rapidly in China. Glycopeptide and aminoglycoside antibiotics are currently approved by doctors and pharmacists, but the development of β-lactams in critically ill patients is still low. Although we have made great progress in TDM, there are still some shortcomings, such as differences in the rate of submission, insufficient dose or concentration and so on. China should focus on the improvement of the awareness about TDM, and implement individualized treatment through the intervention of clinical pharmacists, in order to improve the clinical efficacy of drugs and reduce the incidence of adverse reactions.
【Key words】 antibiotics; therapeutic drug monitoring; individualized medication

Pharmacokinetic Research on Chinese Herbal Medicines

【Abstract】 In China, herbal medicines are regulated and used as drug products. Such herbal medicines are formulated into contemporary pharmaceutical dosage forms and extensively used in clinics. However, earlier approved Chinese herbal medicines, having therapeutic claims largely based on their established use in Chinese traditional medicine, generally were not tested extensively, owing to the science and technology available at the time. Developing Chinese herbal medicines in line with modern scientific standards will enrich therapeutic armamentarium, especially for complex diseases; this has become necessary to meet expanded regulatory requirements and to ensure sustainable development of such medicines. Pharmacokinetic research on Chinese herbal medicines is an important part of efforts in such development, and it facilitates identification of chemical basis responsible for the medicine’s therapeutic action, designing of herb-herb and herb-drug combination therapies, safety assessment of the medicine, rational clinical use of the medicine and so on. This article describes methodologies for multi-compound pharmacokinetic investigation of Chinese herbal medicines and for investigation of pharmacokinetic herbal medicine-drug interactions and discusses the future development of such investigations.
【Key words】 Chinese herbal medicine; Pharmacokinetics; Pharmacokinetic compatibility

Current status and prospects of Antibacterial TDM in Japan

【Abstract】 It is required in practical clinic to carry out vancomycin administration according to the TDM guide line recently established in Japan. Whereas, actual intervention by pharmacists in TDM of practical vancomycin therapy in all of the cases of the hospital would be difficult. Since administration planning for vancomycin TDM should be carried out not only in the daytime but also in the midnight even in weekend by the pharmacists, education and training of young or new pharmacists are necessary. Accordingly, the establishment of the system to support and educate young pharmacists by the skillful pharmacists is urgently and systematically required. It is important to make the early planning for the vancomycin TDM to establish the first trough blood concentration of vancomycin to be that close to the range required from the attending physician.
【Key words】 TDM; Guide line; Vancomycin; Education and Training

Critical Role and Vision of Pharmacist in Heart Transplant Medical Care in Japan

【Abstract】 We need to create specialized clinical pharmacists for the management of end-stage heart failure. In this article, we will outline our effort as the special team for the management of the patients waiting for heart transplant and the post-heart transplant patients in Japan. Pharmacists skilled at PK/PD and TDM of cardiovascular, antibiotic and immunosuppressive drugs would be key talents in highly-sophisticated medicine in the future.
【Key words】Heart transplant; Ventricular assist device; Therapeutic drug monitoring; Immunosuppressant