山田 成樹

Objective: The purpose of this study was to clarify the importance of therapeutic drug monitoring (TDM) at acute care hospitals using Diagnosis Procedure Combination (DPC) data.<br>Methods: We used DPC data from about 3,500,000 inpatients at about 950 acute care hospitals.  The investigation period was from July 2010 to December 2010.  Patients were divided into 2 groups: TDM intervention (n=22,012); and non-TDM intervention (n=26,400).  We compared the clinical indicators (length of hospital stay, payment based on performance and drug costs) and use of antimicrobials.<br>Results: TDM intervention was carried out in 45.5% patients for whom an anti-MRSA agent was prescribed.  The duration of anti-MRSA agent administration was significantly longer in the TDM intervention group than in the non-TDM intervention group.  The total daily cost of anti-MRSA agents was significantly lower in the TDM intervention group than in the non-TDM intervention group.<br>Conclusion: Our results suggest that TDM intervention is often performed for seriously ill patients who require continuous treatment.  TDM intervention may prevent adverse reactions as a result of adjusting the dosage of the anti-MRSA agent.

Background: Patients with end-stage renal disease (ESRD) have symptoms related to severe anemia, edema, and heart failure. Although dialysis improves ESRD syndromes, the optimum timing for initiation of dialysis is unclear. Recent observational studies have suggested that early commencement of dialysis can be harmful. Given that early dialysis may increase the risk of death, avoiding an early start to dialysis is recommended. Patients with diabetic nephropathy (DN) may have risk factors for early dialysis. However, the risk factors for early dialysis are unclear in ESRD patients with DN. The aim of this study was to elucidate the risk factors for early initiation of dialysis in patients with DN and ESRD. Methods: From April 2009 to December 2012, we identified Japanese DN patients with an estimated glomerular filtration rate of less than 15 mL/minute/1.73 m(2). The patients were divided into late or early dialysis groups based on the timing of start of dialysis. Results: We evaluated 52 patients who commenced dialysis during the observation period, including 33 in the late dialysis group and 19 in the early dialysis group. There was a significant association between early dialysis and age &gt;= 65 years (odds ratio 4.59). The incidence of pneumonia before starting dialysis was significantly higher in elderly patients than in nonelderly patients. Conclusion: Our findings suggest that elderly patients with DN and ESRD have an increased risk of early initiation of dialysis, and occurrence of pneumonia is also associated with early dialysis. To avoid early commencement of dialysis, booster pneumococcal vaccination could be useful in elderly DN patients with ESRD.

原発性骨粗鬆症患者における新規ビスホスホネート(BP)製剤ミノドロネート(MIN)の臨床効果について検討した。新たに骨粗鬆症と診断した100例を、無作為にMIN投与群とアレンドロネート(ALN)投与群に割り付けた。TRACP-5bは、投与開始4週後より両群間において最小有意変化(MSC)を超える低下がみられた。血清NTXは、投与開始24週後より両群間においてMSCを超える低下がみられた。有害事象の発生率は、MIN群24%、ALN群22%で、継続不可となった症例はMIN群4例、ALN群7例で、自己中断などにより継続不可となった症例を含めると、48週継続率はそれぞれMIN群60%、ALN群60%であった。BP製剤の副作用としての膿部不快感がMIN群4例、ALN群4例、腹部膨満感がMIN群のみ3例、腹痛がMIN群1例、ALN群1例であったが、ALN群の腹部不快感1例を除き治療は継続した。