Ann Lab Med.  2014 Jan;34(1):1-6. 10.3343/alm.2014.34.1.1.

Assessment of Therapeutic Drug Monitoring of Vancomycin in Elderly Patients According to New Guidelines

Affiliations
  • 1Department of Laboratory Medicine, Ewha Womans University School of Medicine, Seoul, Korea. kshong@ewha.ac.kr
  • 2Department of Pharmacy, Ewha Womans University School of Medicine, Seoul, Korea.
  • 3Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea.
  • 4Ewha Clinical Trial Center, Ewha Womans University School of Medicine, Seoul, Korea.

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.

Keyword

Therapeutic drug monitoring; Vancomycin; Trough concentration

MeSH Terms

Aged
*Drug Monitoring
Female
Gram-Positive Bacterial Infections/drug therapy
Guidelines as Topic
Half-Life
Humans
Injections, Intravenous
Male
Middle Aged
Vancomycin/*blood/pharmacokinetics/therapeutic use
Vancomycin

Figure

  • Fig. 1 Number of patients and predicted vancomycin trough concentrations to show the target vancomycin trough concentrations comprised the target ranges according to different guidelines.


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