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Impact of Trough Concentration for Vancomycin Therapy with Initial Dosage

Ayako SUZUKI1), Hironori TANAKA2), Mikako NAMIKI1)3), Hirokazu IKEDA3), Mari KOGO4) and Tadanori SASAKI2)
1)Department of Pharmacy, Showa University Fujigaoka Hospial2)Hospital Pharmaceutics, Showa University School of Pharmacy3)Department of Infection Control Team, Showa University Fujigaoka Hospial4)Division of Pharmacotherapeutics Department of Clinical Pharmacy, Showa University School of Pharmacy

Vancomycin (VCM) is considered to be effective for the treatment of methicillin-resistant Staphylococcus aureus. Since VCM has narrow therapeutic index, therapeutic drug monitoring (TDM) is helpful for the optimal management of VCM therapy. Because we need to support the Antimicrobial Stewardship Program, we assessed the effect of the VCM therapy with initial dosage calculated using the actual body weight and the creatinine clearance (Ccr). We analyzed dosing methods and outcomes of 211 cases that received VCM therapy from June 2013 to July 2015. We compared with trough level between initial dose setting group and non-setting group retrospectively. Subsequently, we compared this method and revised edition of TDM guideline of 2016 with estimate glomerular filtration rate (eGFR) related to initial dose setting.Execution rate of setting dose of VCM was 56.9%. Achievement rate of 10-15 μg/mL at the 1st TDM in setting group was 42.5%, which was significantly higher than that in non-setting group (14.2%) (p<0.001). We changed the dosage of setting group (30.8%) was significantly lower than that of non-setting group (56.0%) (p<0.001). 43 cases corresponded to the revised guideline. 27.9% had reached 10-15 μg/mL trough levels of VCM. We also compared with trough level between setting group and non-setting group for the patients of good renal function (eGFR≥80 mL/min/1.73 m2). We found the 63.5% patients of non-setting group could not reach 10 μg/mL of VCM trough concentration at the 1st TDM.In this study, we identified that the VCM therapy with initial dosage setting by using the actual body weight and Ccr followed by TDM guideline is a simple and easy method. Especially, we need the loading dose for good renal function. This therapy is also supposed to be available for the initial dosage setting.

Key words:vancomycin, Antimicrobial Stewardship Program, initial dosage setting, therapeutic drug monitoring


Received: November 28, 2016
Accepted: June 22, 2017

32 (5):250─257,2017

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