The Value of Therapeutic Drug Monitoring of Vancomycin in Treatment in a Tertiary Hospital, Cho Ray Hospital, Viet Nam
Journal Title: Journal of Advances in Medicine and Medical Research - Year 2016, Vol 16, Issue 6
Abstract
Aims: To evaluate the value of therapeutic drug monitoring (TDM) of vancomycin in clinical practice. Methods: To review retrospectively on 292 hospital cases (111 females, 181 males) treated with vancomycin, July to October 2014, at ChoRay Hospital. The main evaluating parameters were TDM criteria for vancomycin (dose, dosing interval, times of monitoring), trough level, dose adjustment, renal function follow-up, minimum inhibitory concentration of infectious agents, clinical response. Results: Two hundred seventy-five patients (94.2%) received routine dose of 1 g vancomycin per IV infusion time. Dosing interval was given correctly to estimated glomerular filtration rate (eGFR) level 80.8% (235/291). The 1st monitoring after 9th dose was in 139 cases (47.6%). Trough level was lower than 10 mg/L in 86 patients (29.5%), higher than 20 mg/L in 96 (32.9%), and 110 in optimal range 10-20 mg/L (37.7%). Age and eGFR were 2 independent predictors for trough level. Dose adjustment were done in 6.9% (6/86) patients 10 mg/L, 20.8% (20/96) ones >20 mg/L, and 11.8% (13/110) ones 10-20 mg/L. Vancomycin concentrations in young patients were lower than those in elderly ones with OR = 5.9 [95%CI: 2.6 – 14.0], p = 0.0001. Response sensitivity was 69.3% (13/19) for dose reduction, and 83.3% (5/6) for dose increase. Dose adjustment did not make change in trough level compared to unadjusted ones. Nephrotoxicity rate was found as 8.4%. Treatment failure was 50% in patients with trough concentration/minimum inhibition concentration ratio ≤ 10 compared to 15% in ones with higher ratio > 10, p = 0.034. The failure rate was highest in patients received vancomycin 7 days (22/70: 31.4%), OR: 4 (2.0-7.7) p=0.002. The clinical AUC/MIC ratio cut-off, 190 mg/L/day, had 75.9% and 66.7%, respectively for sensitivity and specificity to predict the success result in treatment. Conclusion: The criteria of TDM on vancomycin were not applied strictly, especially for dosing intervals, dosing adjustment and follow-up thereafter. The clinical pharmacodynamics of vancomycin is dependent on both concentration and duration of treatment.
Authors and Affiliations
Le Huu Hoang, Lam Tran Nha Quyen, Le Ngoc Hung
Keywords
Related Articles
- EP ID EP341525
- DOI 10.9734/BJMMR/2016/26806
- Views 83
- Downloads 0
Perception about Working in Rural Area after Graduation and Associated Factors: A Study among Final Year Medical Students in Medical Schools of Southeast Nigeria
Aims: Aim of study was to determine the perception of rural medical practice among final year medical students in medical schools of southeast Nigeria and the associated factors. Study Design: Descriptive cross-sectional...
Air-Migration after Ureteral Intervention: A Prospective Case Series
Aims: To investigate whether air in the kidney or bladder is only associated with gas-forming infection, or whether it can be observed after endoscopic interventions including ureteral and cystoscopic. If this is the cas...
The Relation between the Clinical Presentation of Acute Carbon Monoxide Toxicity and Carboxy-hemoglobin Level
Background and Objective: The symptoms of carbon monoxide (CO) poisoning are nonspecific; symptoms can mimic those of other common diseases such as nonspecific viral illness, flu- like syndrome and hypertensive attack. E...
Stem Cell and Its Banking: Current Trends and Developments
Stem cells are immature cells capable of self-renewal and differentiation into mature cells. They are of different types and functionally diverse depending on the site it is produced. A major leap in stem cell culture is...
Prevalence of AmpC Beta-lactamase in Gram Negative Bacilli by Different Phenotypic Methods in a Tertiary Care Institute in Kashmir
Context: AmpC type cephalosporinases are Ambler class C β-lactamases. They hydrolyze penicillins, cephalosporins; except the fourth-generation compounds and monobactams. To the best of our knowledge prevalence of AmpC in...