Abstract
Under the Japanese health insurance system, medicines undergoing therapeutic drug monitoring (TDM) can be billed for medical fees if they meet the specified requirements. In Japan, TDM of vancomycin, teicoplanin, aminoglycosides, and voriconazole, which are used for the treatment of infectious diseases, is common practice. This means the levels of antibiotics are measured in-house using chromatography or other methods. In some facilities, the blood and/or tissue concentrations of other non-TDM drugs are measured by HPLC and are applied to treatment, which is necessary for personalized medicine. This review describes personalized medicine based on the use of chromatography as a result of the current situation in Japan.
Highlights
Importance and Reality of TDM forIn Japan, insurance claims based on therapeutic drug monitoring (TDM) became possible for lithium carbonate in the treatment of manic depression in 1980, followed by antiepileptic drugs and digitalis the following year
-The measured concentrations in blanks were less than 20% of the peak response of the lower limited of quantification and less than 5% for internal standard and Cpeak in patients with CLcr of
HPLC:high performance liquid chromatography; HPLC-UV:high performance liquid chromatography with ultraviolet detection; Scr:serum creatinine; CSF: cerebrospinal fluid; IQR:interquartile range; RSD: relative standard deviation; nd: not described; LC-MS/MS:Liquid Chromatograph-tandem Mass Spectrometer; UPLC-MS/MS:ultra-performance liquid chromatography coupled to tandem mass spectrometry; HPLC-PDA:high-performance liquid chromatography equipped with photodiode array; CLcr:creatinine clearance; methicillin-resistant Staphylococcus aureus (MRSA): methicillin resistant Staphylococcus aureus; UHPLC-MS/MS:ultra-high-performance liquid chromatography coupled with tandem mass spectrometry
Summary
In Japan, insurance claims based on therapeutic drug monitoring (TDM) became possible for lithium carbonate in the treatment of manic depression in 1980, followed by antiepileptic drugs and digitalis the following year. The therapeutic benefits of TDM have been confirmed, the number of drugs covered has gradually expanded, and insurance billing rates have increased. When the blood concentration of the administered drug is measured and the dosage is precisely controlled based on the results, the associated costs can be calculated and billed only once in a calendar month. In the 1980s and 1990s, high-performance liquid chromatography (HPLC) played a significant role in the analysis of drug concentrations in blood. The blood and tissue concentrations of other drugs are measured by HPLC and are applied to treatment, which is necessary for personalized medicine. Res. Public Health 2022, 19, 2516 significance of TDM and methods for measuring blood concentrations with examples from our own experience. TDM Guidelines 2022 [4]
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