Assessment of Therapeutic Drug Monitoring of Vancomycin in Elderly Patients According to New Guidelines.
- Author:
Se Jin OH
1
;
Ki Sook HONG
;
Eun Jeong LEE
;
Hee Jung CHOI
;
Kyoung Ae KONG
;
Miae LEE
;
Wha Soon CHUNG
Author Information
- Publication Type:Original Article
- Keywords: Therapeutic drug monitoring; Vancomycin; Trough concentration
- MeSH: Aged; *Drug Monitoring; Female; Gram-Positive Bacterial Infections/drug therapy; Guidelines as Topic; Half-Life; Humans; Injections, Intravenous; Male; Middle Aged; Vancomycin/*blood/pharmacokinetics/therapeutic use
- From:Annals of Laboratory Medicine 2014;34(1):1-6
- CountryRepublic of Korea
- Language:English
- 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.
