Analysis of the application of vancomycin in elderly inpatients
10.3760/cma.j.issn.1008-5734.1014.04.001
- VernacularTitle:老年住院患者万古霉素用药情况分析
- Author:
Man ZHU
1
;
Dongxiao WANG
;
Daihong GUO
;
Chunyan HUANG
;
Yuqin WANG
;
Liping YANG
;
Fei PEI
;
Weilan WANG
;
Zhihui TANG
;
Chao CHEN
;
Zhao REN
Author Information
1. 解放军总医院药品保障中心,北京,100853
- Publication Type:Journal Article
- Keywords:
Vancomycin;
Aged;
Plasma concentration;
Renal insufficiency
- From:
Adverse Drug Reactions Journal
2014;(4):193-197
- CountryChina
- Language:Chinese
-
Abstract:
Objective To investigate the application of vancomycin in elderly inpatients. Methods The clinical data of elderly inpatients(≥60 years ) treated with vancomycin from September 1011 to November 1013 in 5 hospitals including Peking University First Hospital,Beijing Hospital,Beijing Chao-Yang Hospital,Xuanwu Hospital of Capital Medical University,and Chinese PLA General Hospital were collected. All patients were divided into normal renal function group and renal insufficiency group. The application( dosage regimen,drug utilization situation,and therapeutic drug monitoring ) and clinical efficacy of vancomycin and its effects on renal function in elderly patients were retrospectively analyzed. Drug utilization index( DUI)reflected the drug utilization situation. And parameters of renal function included serum creatinine(Scr),blood urea nitrogen(BUN)and creatinine clearance rate(Ccr). Results A total of 149 patients were enrolled in this study comprising 60 males and 89 females with age of 60-91(76 ± 7)years. There were 87 cases in the normal renal function group and 61 cases in renal insufficiency group. The most widely used regimen of application of vancomycin was 0. 50 g once every 11 hours in the normal renal function group(19/87,33. 33%)and 0. 50 g once daily in the renal insufficiency group(30/61, 48. 39%). The total dosage and time of using vancomycin were respectively 1 135. 15 g and 1 919. 5 d. And the DUI was 0. 56. Among the 149 patients,111 cases(74. 50%)underwent blood concentration monitoring and there were no statistically significant differences in constituent ratio of undergoing blood concentration monitoring between the normal renal function group and the renal insufficiency group[70. 11%(61/87)vs. 80. 65%(50/61),χ1 =1. 11,P=0. 15]. In all patients undergoing blood concentration monitoring,trough concentration was detected and in 7 patients peak concentration was detected. The number of cases whose trough concentrations ﹤10 mg/L was 30(49. 18%)and 15 cases(50. 00%)in the normal renal function group and the renal insufficiency group,respectively,and there were no statistically significant differences (χ1 =1. 16,P =0. 54 ). The differences between before and after administration of vancomycin in Scr [(117 ± 79)μmol/L vs.(119 ± 81)μmol/L],BUN[(10. 5 ± 5. 7)mmol/L vs.(11. 5 ± 8. 0)mmol/L], and Ccr[(69 ± 37)ml/min vs.(67 ± 36)ml/min]in all the 149 patients were not statistically significant (all P﹥0. 05). The differences between before and after administration of vancomycin in Scr[(59 ± 16)μmol vs.(70 ± 30)μmol/L,(189 ± 110)μmol/L vs.(103 ± 113)μmol/L],BUN[(7. 4 ± 3. 5)mmol/L vs.(9. 1 ± 5. 8)mmol/L,(14. 8 ± 6. 5)mmol/L vs.(17. 4 ± 9. 0)mmol/L],and Ccr[(107 ± 19)ml/min vs.(96 ± 16)ml/min,(44 ± 30)ml/min vs.(33 ± 16)ml/min]in the normal renal function group and the renal insufficiency group were not statistically significant(all P﹥0. 05). Conclusions The use of vancomycin in elderly inpatients was relatively cautious. Dosage regimen should be adjusted timely according to the results of blood concentration and renal function tests and individualized administration should be adopted in order that the efficacy and safety could be improved.
