Study of vancomycin peak concentrations
发布日期：
2024-06-12
浏览次数：
0

Study of vancomycin peak concentrations

Vancomycin (VCM) is a glycopeptide antibiotic that was developed and used in the 1950s to treat aerobic Gram-positive infections, and is currently used primarily to treat methicillin-resistant Staphylococcus aureus (MRSA) infections. Early reports of its nephrotoxicity and ototoxicity raised concerns about VCM use and monitoring of serum VCM concentrations. Overall, the aim of therapeutic drug monitoring (TDM) is to improve clinical outcomes, avoid side effects, and reduce drug costs. In recent years, the policy of separate monitoring of VCM for trough concentrations has spread widely around the world. However, in Japan, most hospitals monitor trough and peak concentrations of VCM. Therefore, in this study, we investigated and analyzed the clinical use of TDM VCM in infected patients and the relationship between its peak concentration and clinical outcome.


VCM






Experiment 1

To investigate whether the practice of TDM has an effect on the patient's kidneys, blood from patients infected with pneumonia or bacteremia was extracted and compared between the TDM group (n553) and the non-TDM group (n546). Characteristics and parameters related to renal function were compared between patients in the TDM and non-TDM groups.


Study of vancomycin peak concentrations


Table 1 Characteristics and parameters related to renal function in patients in the TDM and non-TDM groups (CLcr: creatinine clearance (estimation of CLcr using the Cockcroft-Gault equation), SCr: serum creatinine, VCM: vancomycin)


The results showed that the initial CLcr values were similar in the two groups, and the non-TDM group showed a significant decrease in CLcr values during VCM treatment (p<0.05), and the incidence of elevated SCr was significantly higher than that in the TDM group. Compared with the non-TDM group, the TDM group had a lesser effect on renal!



Experiment 2

To investigate whether the practice of TDM contributes to a shorter duration and dose of VCM therapy, patients with pneumonia or bacteremia infections were extracted and compared between the TDM group (n553) and the non-TDM group (n546). The duration of VCM treatment and total cumulative VCM dose were compared between the two groups.


Study of vancomycin peak concentrations


The results showed that with methicillin-resistant Staphylococcus aureus (MRSA), day 1 CRP values were significantly higher in the TDM group than in the non-TDM group (p < 0.05), and there were no significant differences between the TDM and the non-TDM groups in terms of duration of treatment, lowest CRP value, and total cumulative dose of VCM.




Experiment 3

To evaluate the importance of peak and trough VCM concentrations, subjects in the TDM group were divided into two groups based on peak concentrations:TDM group A, with peak concentrations higher than 25 mg/mL (n=529), and TDM group B, with peak concentrations lower than 25 mg/mL (n=524), to study the relationship between serum VCM concentrations and the duration of VCM treatment in the two groups of patients.


Study of vancomycin peak concentrations


Table 3 Characteristics and outcomes of patients in the TDM and non-TDM groups (Group A: peak vancomycin concentration > 25 mg/mL; Group B: peak vancomycin concentration < 25 mg/mL


The results showed that there was no significant difference in the initial CRP concentration (day 1) between the two groups of patients. the mean duration of VCM treatment was 13 d shorter in group A than in group B (p<0.05); the mean cumulative total dose of VCM in group A was approximately 12 g less than that in group B (p<0.05); and the lowest CRP concentration measured in group A was 1.8 mg/mL lower than that in group B (p<0.05), and by adjusting the peak VCM concentration , clinical outcomes in MRSA-infected patients with pneumonia or bacteremia could be improved.


Study of vancomycin peak concentrations



Spearman's correlation analysis showed a significant correlation between peak concentration and duration of VCM treatment (r=0.51, p< 0.01). Treatment duration varied widely among patients with peak concentrations below 25 mg/mL. The time to bacterial disappearance at the site of infection exceeded 30 d in some patients, whereas the time to bacterial disappearance was mostly less than 30 d in patients with peak concentrations above 25 mg/mL. When the peak VCM concentration was above 25 mg/mL, the treatment duration was significantly shorter in patients with MRSA-infected pneumonia or bacteremia.






Conclusions

In conclusion, peak VCM concentrations should be monitored during VCM therapy in patients with MRSA pneumonia or bacteremia, TDM prevents patients from experiencing nephrotoxicity, and achieving peak VCM concentrations at an appropriate level (higher than 25 mg /mL) is effective in shortening the duration of therapy, reducing the total cumulative dose of VCM, and contributing to the safe administration of the medication and reduction of patient costs.





Diagreat: Therapeutic Drug Monitoring - Fully Automated Chemiluminescent Solution



Based on its chemiluminescence platform, Diagreat provides blood concentration monitoring packages for several series of anti-infective drugs, anti-tumor drugs, immunosuppressants, anti-psychotics, cardiac glycosides, and asthma-alleviating drugs (see table below). Among them, the anti-infective drugs include voriconazole, linezolid and gentamicin in addition to vancomycin, which play an important role in the safe use of drugs in the clinic and the reduction of toxic side effects (see above). DANDA luminescence testing instruments are characterized by high degree of automation, fast testing speed, high detection flux, stable operation, superior performance and perfect traceability, which can provide complete solutions for users at different levels.



Ordering Information



Study of vancomycin peak concentrations


Study of vancomycin peak concentrations

Study of vancomycin peak concentrations

References:

Iwamoto T ,  Kagawa Y ,  Kojima M . Clinical efficacy of therapeutic drug monitoring in patients receiving vancomycin.[J]. Biological & Pharmaceutical Bulletin, 2003, 26(6):876-879.





Last：A case study of sodium valproate and carbapenem drug interactionNext：Importance of cTnI immunoassays

Related Recommendations