Annals of Laboratory Medicine

Korean Society for Laboratory Medicine (대한진단검사의학회)
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Assessment of Therapeutic Drug Monitoring of Vancomycin in Elderly Patients According to New Guidelines

  • Oh, Se Jin (Department of Laboratory Medicine, Ewha Womans University School of Medicine) ;
  • Hong, Ki-Sook (Department of Laboratory Medicine, Ewha Womans University School of Medicine) ;
  • Lee, Eun Jeong (Department of Pharmacy, Ewha Womans University School of Medicine) ;
  • Choi, Hee Jung (Department of Internal Medicine, Ewha Womans University School of Medicine) ;
  • Kong, Kyoung Ae (Department of Ewha Clinical Trial Center, Ewha Womans University School of Medicine) ;
  • Lee, Miae (Department of Laboratory Medicine, Ewha Womans University School of Medicine) ;
  • Chung, Wha Soon (Department of Laboratory Medicine, Ewha Womans University School of Medicine)
  • Received : 2013.04.15
  • Accepted : 2013.08.05
  • Published : 2014.01.02
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Abstract

Background: Concerns regarding increasing microbial resistance to vancomycin have resulted in recommendations for a higher trough serum vancomycin concentration. This study aimed to assess the dosage guidelines targeting vancomycin trough concentrations of 15-20 mg/L. Methods: About 216 adult patients (age, >60 yr) were treated with intravenous vancomycin. The patients were divided into 2 groups according to their target vancomycin trough concentrations: the previous guideline group (n=108) treated with targeted vancomycin trough concentrations of 5-15 mg/L from Jan 2009 through April 2011 and the new guideline group (n=108) treated with targeted concentrations of 15-20 mg/L from November 2011 through July 2012. Results: The 2 groups were not significantly different with respect to age, weight, initial serum creatinine, initial creatinine clearance, predictive trough levels, doses, serum drug concentrations, and area under the curve/minimal inhibitory concentrations. Regarding the proportions of vancomycin trough concentrations, the target range was achieved in 50% in the previous guideline group and in 16% in the new guideline group. In the previous and new guideline groups, the trough concentrations of 10-20 mg/dL were observed in 32.4% and 52.8% patients, respectively, and those of <10 mg/L were observed in 45.4% and 29.6%, respectively. Conclusions: Compared to the previous guideline group, the new guideline group showed higher proportions in the therapeutic range of 10-20 mg/L and lower proportions in trough concentrations <10 mg/L. The strictly managed vancomycin therapeutic drug monitoring in the new guideline group was assessed as more effective.

Keywords

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