Vancomycin Use Pattern and Therapeutic Drug Monitoring in Adult Patients

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Chuleephorn Pitayakittiwong
Siriluk Jaisue
Atibordee Meesing

Abstract

Patients should receive an optimal dose when commencing vancomycin therapy to ensure the rapid achievement of a therapeutic drug level, and then the measured drug level will be used to determine the vancomycin dose for individuals. However, the common initial dose for this drug for adults in Thailand is 1g intravenous every 12 hours and this may not make the blood concentration reach therapeutic range. Objective To study the pattern of vancomycin use in terms of loading dose and maintenance dose as well as to study the plasma drug concentration, pharmacokinetic parameters and correlation between vancomycin dosing and trough concentration. Methods An observational analytic study was conducted in adult patients with stable renal function for at least 72 hours before commencing intravenous vancomycin. The recommended loading dose for vancomycin is 20-35 mg/kg and the recommended maintenance dose is 15-20 mg/kg with the interval adjusted according to renal function. The therapeutic range of vancomycin in blood is 10-20 mg/L. Results A total of 90 patients were recruited into the study. Thirty-seven patients (42.1%) received a loading dose of vancomycin during initiation of therapy and all patients received a maintenance dose. For the 37 patients who received a loading dose of vancomycin, the loading and maintenance doses complied with recommendations in 28 patients (75.7%). Overall, maintenance doses complied with recommendations in 41 patients (45.6%). Vancomycin concentrations were found to be in the therapeutic range for 39 patients (43.3%). This was higher in patients who received the recommended maintenance dose, with 21 patients (51.2%) showing vancomycin concentrations in the therapeutic range. Augmented renal clearance (ARC) was observed in 21 patients (23.3%). Patients with ARC that received the recommended loading dose were four times more likely to have sub therapeutic levels of vancomycin compared to those with mild-impaired or normal renal function (RR = 4.0, 95%CI 0.11 - 0.42, P < 0.05). In addition, ARC patients who received the recommended maintenance dose of vancomycin were 5 times more likely to have drug levels under the therapeutic range compared to others (RR = 5.07, 95%CI 1.98 - 12.95, P < 0.05). Conclusion Providing an optimal initial dose of vancomycin is a key factor to achieving therapeutic levels of vancomycin in patients with normal renal function, mild renal impairment and augmented renal clearance.

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Pharmaceutical Practice

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