title: Evaluation of the vancomycin dosage regimen based on serum creatinine used in the neonatal intensive care unit.
abstract: BACKGROUND
  Vancomycin is frequently used for the treatment of methicillin-resistant Staphylococcus aureus (MRSA) infections; however, determining the optimal dosage for neonates is difficult because of their immature renal function.
  
  
  METHODS
  Serum creatinine-based dosing was introduced in Kumamoto City Hospital Neonatal Medical Center. Serum trough concentration and therapeutic efficacy of vancomycin were evaluated before and after the introduction of the creatinine-based dosing.
  
  
  RESULTS
  When the therapeutic range of serum trough concentration of vancomycin at steady state was set to 5-15 µg/mL, 20 trough concentrations (48.8%) were within the therapeutic range and 21 trough concentrations were outside the therapeutic range before the introduction of the serum creatinine-based dosing. After the introduction of serum creatinine-based dosing, 18 trough concentrations (81.8%) were within the therapeutic range and 4 trough concentrations were not, and there was an increase in the number of patients with trough concentrations in the therapeutic range (P= 0.01; Fisher's exact test).
  
  
  CONCLUSIONS
  The serum creatinine-based dosing of vancomycin is useful in maintaining the appropriate serum level of vancomycin in neonates.
authors.affiliation: Department of Clinical Chemistry and Informatics, Graduate School of Pharmaceutical Sciences, Kumamoto University, Kumamoto, Japan. ikura@gpo.kumamoto-u.ac.jp
authors.forename: Mitsuru
authors.initials: M
authors.lastname: Irikura
authors.forename: Ayako
authors.initials: A
authors.lastname: Fujiyama
authors.forename: Fumi
authors.initials: F
authors.lastname: Saita
authors.forename: Shiori
authors.initials: S
authors.lastname: Fukushima
authors.forename: Hiroki
authors.initials: H
authors.lastname: Kitaoka
authors.forename: Terumi
authors.initials: T
authors.lastname: Fukuda
authors.forename: Akihiko
authors.initials: A
authors.lastname: Kawase
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Kondo
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Ishitsuka
authors.forename: Genzo
authors.initials: G
authors.lastname: Kondo
authors.forename: Toshihide
authors.initials: T
authors.lastname: Maeda
authors.forename: Eiji
authors.initials: E
authors.lastname: Yukawa
authors.forename: Tetsumi
authors.initials: T
authors.lastname: Irie
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000493:pharmacokinetics; D001424:Bacterial Infections / Q000097:blood* / Q000188:drug therapy; D003404:Creatinine / Q000097:blood*; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D008297:Male; D015203:Reproducibility of Results; D012189:Retrospective Studies; D014640:Vancomycin / Q000008:administration & dosage* / Q000493:pharmacokinetics
chemical_list: D000900:Anti-Bacterial Agents; D014640:Vancomycin; D003404:Creatinine