신생아에서의 Vancomycin 용량 가이드라인 적절성 평가
Evaluation of Empiric Vancomycin Dosing Regimens among Neonates in a Korean Tertiary Care Hospital
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초록
Vancomycin is the drug of choice for treatment of methicillin-resistant coagulase-negative Staphylococcus aureus (MRSA) infection in neonatal intensive care units (NICUs). Although the Infectious Disease Society of America (IDSA) and American Society of Hospital Pharmacists (ASHP) recommended that vancomycin trough concentrations remain above 10 mcg/ml in order to prevent resistance, the Neofax guidelines have not recommended a new dosing guideline to achieve the therapeutic dosing goal; this has consequently raised concerns in relation to reaching the therapeutic range. The purpose of this study was to evaluate the rate of achieving serum trough concentrations ranged 10~20 mcg/ml in NICU patients when initial vancomycin dosing was carried out as recommended by the Neofax guidelines. A retrospective chart review was conducted of 63 NICU patients at Seoul National University Bundang Hospital, for whom there was at least one piece of data relating to trough level serum concentrations between June 25, 2003 and July 31, 2015. The duration of therapy, total length of stay, dose adjustments to attain therapeutic range, total daily dose and adverse effects were evaluated. For the primary outcome, 3 patients were excluded because of renal dysfunction, 13 patients were excluded because the initial trough was drawn inappropriately, and 14 patients were excluded because vancomycin was not administrated according to the Neofax guidelines. Only 6 of 38 (15.8%) patients achieved the therapeutic range with empiric dosing following the Neofax guidelines. Postmenstrual age and weight at the beginning of vancomycin treatment were significantly associated with the achievement of the vancomycin therapeutic range. Two out of 60 (3.3%) patients experienced nephrotoxicity. In conclusion, the status of attaining therapeutic range by following the Neofax dosing guideline was suboptimal. Further studies are urgently needed to assist the development of appropriate dosing guidelines for the treatment of MRSA infections in neonates.
Abstract
Vancomycin is the drug of choice for treatment of methicillin-resistant coagulase-negative Staphylococcus aureus (MRSA) infection in neonatal intensive care units (NICUs). Although the Infectious Disease Society of America (IDSA) and American Society of Hospital Pharmacists (ASHP) recommended that vancomycin trough concentrations remain above 10 mcg/ml in order to prevent resistance, the Neofax guidelines have not recommended a new dosing guideline to achieve the therapeutic dosing goal; this has consequently raised concerns in relation to reaching the therapeutic range. The purpose of this study was to evaluate the rate of achieving serum trough concentrations ranged 10~20 mcg/ml in NICU patients when initial vancomycin dosing was carried out as recommended by the Neofax guidelines. A retrospective chart review was conducted of 63 NICU patients at Seoul National University Bundang Hospital, for whom there was at least one piece of data relating to trough level serum concentrations between June 25, 2003 and July 31, 2015. The duration of therapy, total length of stay, dose adjustments to attain therapeutic range, total daily dose and adverse effects were evaluated. For the primary outcome, 3 patients were excluded because of renal dysfunction, 13 patients were excluded because the initial trough was drawn inappropriately, and 14 patients were excluded because vancomycin was not administrated according to the Neofax guidelines. Only 6 of 38 (15.8%) patients achieved the therapeutic range with empiric dosing following the Neofax guidelines. Postmenstrual age and weight at the beginning of vancomycin treatment were significantly associated with the achievement of the vancomycin therapeutic range. Two out of 60 (3.3%) patients experienced nephrotoxicity. In conclusion, the status of attaining therapeutic range by following the Neofax dosing guideline was suboptimal. Further studies are urgently needed to assist the development of appropriate dosing guidelines for the treatment of MRSA infections in neonates.
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