title: Assessment of therapeutic drug monitoring of vancomycin in elderly patients according to new guidelines.
abstract: BACKGROUND
  Concerns regarding increasing microbial resistance to vancomycin have resulted in recommendations for a higher trough serum vancomycin concentration. This study aimed to assess the dosage guidelines targeting vancomycin trough concentrations of 15-20 mg/L.
  
  
  METHODS
  About 216 adult patients (age, >60 yr) were treated with intravenous vancomycin. The patients were divided into 2 groups according to their target vancomycin trough concentrations: the previous guideline group (n=108) treated with targeted vancomycin trough concentrations of 5-15 mg/L from Jan 2009 through April 2011 and the new guideline group (n=108) treated with targeted concentrations of 15-20 mg/L from November 2011 through July 2012.
  
  
  RESULTS
  The 2 groups were not significantly different with respect to age, weight, initial serum creatinine, initial creatinine clearance, predictive trough levels, doses, serum drug concentrations, and area under the curve/minimal inhibitory concentrations. Regarding the proportions of vancomycin trough concentrations, the target range was achieved in 50% in the previous guideline group and in 16% in the new guideline group. In the previous and new guideline groups, the trough concentrations of 10-20 mg/dL were observed in 32.4% and 52.8% patients, respectively, and those of <10 mg/L were observed in 45.4% and 29.6%, respectively.
  
  
  CONCLUSIONS
  Compared to the previous guideline group, the new guideline group showed higher proportions in the therapeutic range of 10-20 mg/L and lower proportions in trough concentrations <10 mg/L. The strictly managed vancomycin therapeutic drug monitoring in the new guideline group was assessed as more effective.
authors.affiliation: Department of Laboratory Medicine, Ewha Womans University School of Medicine, Seoul, Korea.
authors.forename: Se Jin
authors.initials: SJ
authors.lastname: Oh
authors.affiliation: Department of Laboratory Medicine, Ewha Womans University School of Medicine, Seoul, Korea.
authors.forename: Ki-Sook
authors.initials: KS
authors.lastname: Hong
authors.affiliation: Department of Pharmacy, Ewha Womans University School of Medicine, Seoul, Korea.
authors.forename: Eun Jeong
authors.initials: EJ
authors.lastname: Lee
authors.affiliation: Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea.
authors.forename: Hee Jung
authors.initials: HJ
authors.lastname: Choi
authors.affiliation: Ewha Clinical Trial Center, Ewha Womans University School of Medicine, Seoul, Korea.
authors.forename: Kyoung Ae
authors.initials: KA
authors.lastname: Kong
authors.affiliation: Department of Laboratory Medicine, Ewha Womans University School of Medicine, Seoul, Korea.
authors.forename: Miae
authors.initials: M
authors.lastname: Lee
authors.affiliation: Department of Laboratory Medicine, Ewha Womans University School of Medicine, Seoul, Korea.
authors.forename: Wha Soon
authors.initials: WS
authors.lastname: Chung
mesh_terms: D000368:Aged; D016903:Drug Monitoring; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000188:drug therapy; D017408:Guidelines as Topic; D006207:Half-Life; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D014640:Vancomycin / Q000097:blood* / Q000493:pharmacokinetics / Q000627:therapeutic use
chemical_list: D014640:Vancomycin
keywords: Therapeutic drug monitoring; Trough concentration; Vancomycin