TITLE:
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
AUTHORS:
Yasuhiro Kamioka, Hitoshi Suzuki, Masafumi Seki, Ryusuke Ouchi, Shota Kashiwagura, Satoshi Koshika, Yoshiteru Watanabe
KEYWORDS:
Therapeutic Drug Monitoring (TDM), Vancomycin (VCM), Estimate Glomerular Filtration Rate (eGFR), Guideline 2016 (GL2016), Computer Software
JOURNAL NAME:
Pharmacology & Pharmacy,
Vol.9 No.11,
November
15,
2018
ABSTRACT:
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 m2),
but it was similar between the a-2 group and the b-2 group among subjects with
G3 and below (eGFR 60 mL/min/1.73 m2).
The proportion of subjects reaching the various trough ranges shows similar
tendency. Conclusions: These
data suggested that the measured trough value on day 3 was generally lower when
the initial dose was established using the eGFR nomogram based on the GL2016,
and this was especially prominent among patients with normal renal function. As
for subjects with low renal function, the trough values were relatively high
while ensuring safety.