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The Journal of the Japanese Society for Clinical Microbiology |
Biblioraphy Information
| ArticleTitle |
The Need for Therapeutic Drug Monitoring (TDM) When Treating Patients with Vancomycin Hydrochloride: Points to Consider |
| Language |
J |
| AuthorList |
Shouichi Sato1), Yoshiko Saito1), Hiroko Sato2) |
| Affiliation |
1) Department of Clinical Laboratory, Chiba Cardiovascular Center
2) Department of Clinical Laboratory, Chiba Children's Hospital |
| Publication |
J.J.C.M.: 15 (3), 111-119, 2005 |
| Received |
December 1, 2004 |
| Accepted |
July 29, 2005 |
| Abstract |
To maximize the efficacy of antimicrobial agents, it is necessary to select the most suitable antimicrobial agent for the patient, establish the most suitable dosage regimen, and monitor the patient for adverse effect of drug. We have performed the therapeutic drug monitoring (TDM) of vancomycin (VCM), which is frequently used to treat methicillin resistant Staphylococcus aureus (MRSA) infections. TDM has been performed on 34 patients with MRSA, together with methicillin resistant Staphylococcus epidermidis (MRSE) infection. They were treated with VCM between November 2003 and October 2004. The computer-simulation analysis showed that the rate of achieving the therapeutic range of VCM (trough values of 5 to 15 μ g/ml and peak values of 25 to 40 μ g/ml), was only 21%. Most cases of VCM blood concentration levels were found to be below the therapeutic range. When TDM was performed by measuring the blood concentration levels of VCM, it was possible to change the dose and interval of the drug for the most suitable blood concentrations that are within the drug's therapeutic range, thus TDM was considered to be useful. We also evaluated the formula used to calculate creatinine clearance (Ccr), an important element of simulation analysis. The correlation coefficient with observed values was approximately r=0.76, which is unacceptable for practical application. Therefore, it is necessary to measure the actual Ccr, followed by establishing dose regimen. The performance of TDM of VCM in a microbiology laboratory is suggested to contribute to the feedback of the clinically useful information, as it informs the detection of causative bacteria, the MIC of the bacteria, etc. |
| Keywords |
VCM, TDM, MRSA, PK/PD |
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