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

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  • 抗菌薬TDMガイドライン改訂版の発刊によるバンコマイシンの使用動向の変化とその効果に関する検討

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<p>The Therapeutic Drug Monitoring (TDM) Guidelines for Antibiotics (the “Revised guidelines”) were revised in June 2016. The Revised guidelines are followed to determine dosage and provide treatment at Osaka City University Hospital. The current study investigated VCM administration before and after the guidelines were revised as well as their effectiveness and safety. The period from January to December 2015 before the guidelines were revised (“before Revision”) and the period from January to December 2017 after the guidelines were revised (“after Revision”) were compared. One hundred and six patients received VCM therapy before Revision, and 184 received VCM therapy after Revision. Initially, 17.4％ of patients had the recommended serum VCM level of 10-15 µg/mL, but that increased to 41.7％ as a result of a pharmacist’s involvement; 72.8％ of patients had serum VCM below 10 µg/mL after Revision. Acute kidney injury (AKI) was evaluated based on the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. The incidence of AKI was 12.3％ before Revision and 5.4％ after Revision, so it was significantly lower before Revision. The 30-day survival rate was 94.6％ before Revision and 95.3％ after Revision, so the rate did not differ significantly.</p><p>When VCM therapy was administered in accordance with the Revised guidelines, the initial serum trough level of VCM was lower than 10 µg/mL in most patients, and VCM slightly affected the kidneys. Most patients had a serum VCM of 10-15 µg/mL as a result of a pharmacist’s intervention, suggesting that the serum VCM level did not affect prognosis.</p>

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