Impact of Trough Concentration for Vancomycin Therapy with Initial Dosage

Suzuki, Ayako; Tanaka, Hironori; Namiki, Mikako; Ikeda, Hirokazu; Kogo, Mari; Sasaki, Takeshi

doi:10.4058/jsei.32.250

Cited by 4 publications

(2 citation statements)

References 7 publications

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“…retrospectively examined the degree of reaching trough levels in the GL2016 group and found that 27.9% of the subjects in the TDM implementation group had reached a range between 10 and 15 μg/mL, which was similar to the results of the present study (31%) [5]. However, in their study, 11.6% of the subjects had trough levels that exceeded 20 μg/mL, which was different from the results of the present study.…”

Section: Discussioncontrasting

confidence: 57%

Comparison of Measured Trough Values after Deriving the Initial Dose Setting of Vancomycin with a Conventional Computer Software and a Nomogram Based on the Revised Japanese 2016 Therapeutic Drug Monitoring Guidelines for Antimicrobial Agents

Kamioka¹,

Suzuki²,

Seki³

et al. 2018

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Background: Due to the relatively high renal toxicity of vancomycin injection (VCM), setting an initial dose that achieves a trough that ranges between 10 and 20 μg/mL on day 3 is important to ensure safety and minimize side-effects, especially for patients with low renal function. To address these issues, the revised 2016 Therapeutic Drug Monitoring (TDM) Guidelines for Antimicrobial Agents (GL2016) proposed the use of a renal function-based, estimate glomerular filtration rate (eGFR) nomogram for setting the dose of VCM in Japan. Methods: Our hospital introduced the use of the GL2016 in September 2016 for the patients administered VCM. After setting the initial VCM dose using 1) a conventional VCM analysis software and 2) the GL2016 eGFR nomogram, the measured trough values on day 3 were compared and evaluated in this study. Results: With the VCM analysis software, the mean measured trough value in the a-total group (n = 53) was 12.8 ± 4.7 μg/mL. With the eGFR nomogram, the mean measured trough value in the b-total group (n = 13) was 9.6 ± 4.6 μg/mL. However, when the different severities of renal function were compared, the mean measured trough value was more significantly lower in the b-1 group than in the a-1 group among subjects with G2 and above (eGFR ≥ 60 mL/min/1.73 m 2), but it was similar between the a-2 group and the b-2 group among subjects with G3 and below

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Section: Discussioncontrasting

confidence: 57%

Comparison of Measured Trough Values after Deriving the Initial Dose Setting of Vancomycin with a Conventional Computer Software and a Nomogram Based on the Revised Japanese 2016 Therapeutic Drug Monitoring Guidelines for Antimicrobial Agents

Kamioka¹,

Suzuki²,

Seki³

et al. 2018

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show abstract

“…17 Suzuki et al retrospectively examined the proportion of patients who achieved the recommended trough levels in the GL2016 group and found that 27.9% of the subjects in the TDM implementation group achieved a trough level ranging between 10 and 15 μg/mL, although 11.6% of the subjects had trough levels that exceeded 20 μg/mL, similar to the results of our previous study (31%). 11,18 The reasons for these variable results might be due to differences in the patients' background characteristics, including age and inflammation status, as is reflected by ARC, which might frequently lead to the underestimation of renal function and the VCM doses that should be given. Therefore, AUC-guided monitoring is usually recommended over trough-guided monitoring, although both VCM trough concentrations and AUC values correlate with its efficacy and safety.…”

Section: Discussionmentioning

confidence: 99%

Analysis of Risk Factors Associated with Reduced Trough Concentrations of Vancomycin in Relation to Renal Function in a Tertiary Hospital in Japan

Kashiwagura

Kamioka

Seki

et al. 2021

IDR

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Background: Low trough concentrations of vancomycin (VCM) are common in patients receiving the drug, because patients are often administered relatively low doses of VCM due to its high potential for renal toxicity. However, the clinical risk factors associated with low VCM trough concentration in relation to renal function are unclear. Methods: Patients at our hospital who received VCM intravenously from January 2018 to December 2020 were analyzed. The patients were divided into two groups based on their renal function: normal and lower renal function, such as estimated glomerular filtration rate (eGFR) ≧60 and <60 mL/min/1.73 m 2 , respectively. In each renal function group, patients' background characteristics, laboratory data and treatments were compared between lower VCM concentration (<10 mg/L) and appropriate VCM concentration (10-20 mg/L) subgroups. Results: Among 101 patients with normal renal function, 47 and 54 patients, respectively, showed lower and appropriate VCM trough concentrations. Elderly age, short stature, and higher C-reactive protein (CRP) level were significantly more common in the lower VCM concentration group compared with appropriate VCM concentration group. Among the 45 patients with renal dysfunction, 20 and 25 patients, respectively, showed lower and appropriate VCM trough concentrations. CRP levels were significantly higher in lower VCM concentration than appropriate VCM concentration subgroups. Multivariate analysis showed that insufficient total VCM doses and higher CRP might have affected the lower VCM trough concentration in patients with normal renal function. Conclusion:The results of this study suggest that higher CRP might be one of the risk factors associated with lower VCM concentration in both normal and low renal function patients. Severely ill and emergency patients might receive a lower VCM dose due to underestimation of the acceptable VCM dose.

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Efficacy and Safety of Vancomycin in Treatment based on the TDM Guideline for Antibiotics 2016

Nakamura

Harabayashi

Sakurai

et al. 2019

Jpn. J. Pharm. Health Care Sci.

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Impact of Trough Concentration for Vancomycin Therapy with Initial Dosage

Cited by 4 publications

References 7 publications

Comparison of Measured Trough Values after Deriving the Initial Dose Setting of Vancomycin with a Conventional Computer Software and a Nomogram Based on the Revised Japanese 2016 Therapeutic Drug Monitoring Guidelines for Antimicrobial Agents

Comparison of Measured Trough Values after Deriving the Initial Dose Setting of Vancomycin with a Conventional Computer Software and a Nomogram Based on the Revised Japanese 2016 Therapeutic Drug Monitoring Guidelines for Antimicrobial Agents

Analysis of Risk Factors Associated with Reduced Trough Concentrations of Vancomycin in Relation to Renal Function in a Tertiary Hospital in Japan

Efficacy and Safety of Vancomycin in Treatment based on the TDM Guideline for Antibiotics 2016

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