Preferable timing of therapeutic drug monitoring in patients with impaired renal function treated with once-daily administration of vancomycin.
The aim of this study was to investigate the timing of therapeutic drug monitoring (TDM) in patients with impaired renal function treated with once-daily administration of vancomycin (VCM). Once-daily administration was selected for patients whose creatinine clearance (Ccr) was <80 ml/min. TDM was conducted on day 3 or on day 4. Adult patients whose VCM dosage was not altered according to initial C min and for whom subsequent follow-up TDM was performed within 1 week were entered into the study. Patients whose renal function deteriorated at follow-up TDM were excluded. One hundred sixty-five patients were eligible for analysis. Among patients with once-daily dosing, relative increases of C min at follow-up TDM compared with initial TDM were 34.5 ± 39.2 % in TDM on day 3 and 16.6 ± 20.6 % in TDM on day 4 (P = 0.016). In contrast, there was no significant difference in the relative increase of C min between TDM on days 3 and 4 (26.1 ± 39.6 vs. 18.4 ± 25.6 %, P = 0.551) in the twice-daily regimen. On multivariate analysis, TDM on day 3 alone (odds ratio, 4.93; 95 % confidence interval, 1.71-14.2) was selected as an independent risk factor associated with a relative increase of C min by >30 % in the once-daily regimen. Steady-state VCM serum concentration was not achieved on day 3 in the once-daily regimen in patients with impaired renal function, and TDM on day 3 caused underestimation of C min.
Department of Pharmacy, The Hospital of Hyogo College of Medicine, 1-1, Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan. yktabu@hyo-med.ac.jp
Yoshiko
Y
Takahashi
Yoshio
Y
Takesue
Shingo
S
Takubo
Mika
M
Ishihara
Kazuhiko
K
Nakajima
Toshie
T
Tsuchida
Hiroki
H
Ikeuchi
Motoi
M
Uchino
D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000097:blood / Q000493:pharmacokinetics*; D001424:Bacterial Infections / Q000188:drug therapy* / Q000378:metabolism; D016903:Drug Monitoring / Q000379:methods*; D013293:Enterococcus faecalis / Q000302:isolation & purification; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000188:drug therapy / Q000378:metabolism; D006801:Humans; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification; D008875:Middle Aged; D011446:Prospective Studies; D051437:Renal Insufficiency / Q000378:metabolism* / Q000382:microbiology; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000188:drug therapy / Q000378:metabolism; D013997:Time Factors; D014640:Vancomycin / Q000008:administration & dosage* / Q000097:blood / Q000493:pharmacokinetics
D000900:Anti-Bacterial Agents; D014640:Vancomycin