title: Initial dose of vancomycin based on body weight and creatinine clearance to minimize inadequate trough levels in Japanese adults.
abstract: Our aims were to elucidate the factors that affected vancomycin (VCM) serum trough levels and to find the optimal initial dose based on creatinine clearance (CrCl) and body weight (BW) to minimize inadequate trough levels in a retrospective observational study among Japanese adults. One hundred and six inpatients, in whom VCM trough levels were measured after completing the third dosing, were consecutively recruited into our study in a tertiary hospital. We considered the frequency of <30% as low. In the generalized linear model, initial VCM total daily dose, CrCl, and BW were independent risk factors of VCM trough levels. In patients with CrCl ≥30 and <50 mL/min, 1 g/day yielded low frequencies of a trough level of ≥20 mcg/mL, regardless of BW. In patients with CrCl ≥50 mL/min, 2 g/day yielded low frequencies of a trough level of <10 mcg/mL in patients weighing <55 kg, but not in patients weighing ≥55 kg. Optimal VCM initial total daily dose may be 1 g/day in patients with CrCl ≥30 and <50 mL/min regardless of BW and 2 g/day in patients weighing <55 kg with CrCl ≥50 mL/min among Japanese adults.
authors.affiliation: Department of General Internal Medicine, Shizuoka General Hospital, Shizuoka City, Shizuoka, Japan.
authors.forename: N
authors.initials: N
authors.lastname: Maki
authors.forename: A
authors.initials: A
authors.lastname: Ohkuchi
authors.forename: Y
authors.initials: Y
authors.lastname: Tashiro
authors.forename: M R
authors.initials: MR
authors.lastname: Kim
authors.forename: M
authors.initials: M
authors.lastname: Le
authors.forename: T
authors.initials: T
authors.lastname: Sakamoto
authors.forename: S
authors.initials: S
authors.lastname: Matsubara
authors.forename: Y
authors.initials: Y
authors.lastname: Hakamata
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044466:Asian People; D015992:Body Mass Index; D001835:Body Weight; D003404:Creatinine / Q000378:metabolism*; D054796:Drug Dosage Calculations; D005260:Female; D006801:Humans; D016014:Linear Models; D008297:Male; D008657:Metabolic Clearance Rate; D055624:Methicillin-Resistant Staphylococcus aureus / Q000472:pathogenicity; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000188:drug therapy / Q000382:microbiology; D062606:Tertiary Care Centers; D014640:Vancomycin / Q000008:administration & dosage* / Q000097:blood / Q000493:pharmacokinetics*; D055815:Young Adult
chemical_list: D014640:Vancomycin; D003404:Creatinine