Infect Chemother.  2009 Aug;41(4):224-229. 10.3947/ic.2009.41.4.224.

Evaluation of the Effect of Initial dose of Vancomycin using Serum Cystatin C as a Marker in Elderly Patients

• Jin SJ
• Bae SC
• Kim HW
• Kim HK
• Na EJ
• Ahn BS
• Choi JY
• Kim CO
• Kim JM
• Song YG

• KMID: 1473665
• DOI: http://doi.org/10.3947/ic.2009.41.4.224

Abstract

BACKGROUND
It has been suggested that the glomerular filtration rate can be predicted on the basis of serum cystatin C concentration. The aim of this study was to investigate the clinical utility of serum cystatin C as a marker of renal function and to evaluate the effect of an initial dose of vancomycin using serum cystatin C concentration in elderly patients. MATERIALS AND METHODS: Data was collected from July 2006 to September 2008. The subjects were elderly patients (> or =60-years-of-age; n=number of patients) who had been treated with vancomycin. Serum concentrations of parameters including vancomycin, creatinine, and cystatin C were measured. Correlations between measured vancomycin concentrations and predicted vancomycin concentrations based on serum cystatin C or serum creatinine were compared, and the initial dose setting of vancomycin on the basis of serum cystatin C concentration was evaluated. RESULTS: Serum cystatin C was a good marker of renal function in comparison with serum creatinine for various doses of vancomycin in the elderly subject. In subpopulation (n=88) with normal serum cystatin C level (< or =1.2 mg/L) who were treated with routine adult vancomycin dose (1g q 12 hours), vancomycin concentration was within the therapeutic range (5-15 mg/L) in 68 patients (77.3%), and was <20 mg/L in 77 of the 88 patients (88.5 %). CONCLUSIONS: Predictive prowess of serum vancomycin concentrations on the basis of the serum cystatin C concentration could be better than that based on the serum creatinine concentration in elderly patients.

Keyword

Vancomycin; Therapeutic drug monitoring; Cystatin C

MeSH Terms

Adult
Aged
Creatinine
Cystatin C
Drug Monitoring
Glomerular Filtration Rate
Humans
Vancomycin
Creatinine
Cystatin C
Vancomycin

Figure

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  Figure 1 Correlations between measured and predicted vancomycin concentration on the basis of serum creatinine (A) and serum cystatin C (B).

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  Figure 2 Distribution of serum cystatin C concentration at normal range of serum creatinine concentration (≤1.0 mg/dL).

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  Figure 3 Distribution of serum creatinine concentration at normal range of serum cystatin C concentration (≤1.2 mg/L).

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