Clinical efficacy of therapeutic drug monitoring in patients receiving vancomycin.
Efficacy of therapeutic drug monitoring (TDM) of vancomycin (VCM) was retrospectively investigated in 184 patients with methicillin-resistant Staphylococcus aureus (MRSA) infection. The incidence of nephrotoxicity was compared between the patients who received TDM practice (TDM group, n=73) and did not (non-TDM group, n=111). Creatinine clearance (CLcr) values decreased significantly after the VCM therapy in the non-TDM group (p<0.05). The patients with MRSA bacteremia or pneumonia were classified into two groups according to peak concentrations of VCM: above 25 microg/ml (Group A: n=29) and below (Group B: n=24). Mean duration of VCM therapy (14.1 d) in Group A was significantly shorter than that (27.0 d) in Group B. Mean cumulative total VCM doses (13.3 g) in Group A was significantly less than that (25.0 g) in Group B. These results indicate that monitoring peak concentration is essential to obtain better clinical effects for VCM therapy, and that the peak concentration above 25 microg/ml is more effective.
Iwamoto
Takuya
T
Department of Hospital Pharmacy, Mie University School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan. taku-iwa@clin.medic.mie-u.ac.jp
Kagawa
Yoshiyuki
Y
Kojima
Michio
M
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000097:blood* / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D016903:Drug Monitoring; D004363:Drug Utilization / Q000639:trends; D005260:Female; D006801:Humans; D007223:Infant; D007262:Infusions, Intravenous; D008297:Male; D016106:Methicillin Resistance; D008875:Middle Aged; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000188:drug therapy; D013211:Staphylococcus aureus / Q000187:drug effects; D014640:Vancomycin / Q000008:administration & dosage / Q000097:blood* / Q000627:therapeutic use
D000900:Anti-Bacterial Agents; D014640:Vancomycin