크레아티닌 클리어런스 60ml/min 이상 성인 환자에서 Vancomycin 임상약동학 자문업무의 유용성 평가

Abstract

It is now well established that the bactericidal activity of vancomycin is not temporally stationary. As a result, clinical pharmacokinetics consultation service (CPCS) become necessary for the maintenance of the trough concentration of vancomycin to minimize adverse effect while maximizing therapeutic effect. In particular, CPCS was essential in geriatric, pediatric patients or patients over moderate stage kidney disease patients with creatinine clearance (CLcr) < 60ml/min (by National Kidney Foundation standards) for successful vancomycin therapy. However, in previous studies, CPSS was claimed to be not clinically relevant in adult patients with CLcr ≥ 60ml/min. Therefore, the objective of the present study was to evaluate the merit of CPCS and the factor(s) influencing the results of CPCS in adult patients with CLcr ≥ 60ml/min. Accordingly, the patients, from 18 to 65 years of age, with calculated CLcr values above of 60ml/min by Cockroft-Gault equation received vancomycin CPCS between January and June 2008 in Seoul National University Bundang Hospital; The electronic medical records (EMRs) of the patients were retrospectively reviewed. The patients were first classified into the maintenance dose group, the increased dose group or the reduced dose group according to CPCS results. A number of factors, such as gender, age, body weight, CLcr, duration of therapy, indication, dosage, combination of nephrotoxic drugs and occurrence of adverse effects, were studied for the potential impact on the results of CPCS. Among 132 cases, 83 cases were categorized as the maintenance dose group, 30 cases as the increased dose group, and 19 cases as the reduced dose group; The rate of patients having the dose adjustment was 37.1%. A significant (44.7%) number of patients received medications that potentially affected renal function (e.g., diuretics, aminoglycosides, amphotericin B). Approximately 6.1% of the patients experienced adverse effects (e.g., renal failure and thrombocytopenia) related to vancomycin administration. Statistical analysis indicate that age and CLcr show statistical significance between the three groups, suggesting vancomycin dose adjustment is necessary in the younger patients and/or patients having higher CLcr. When vancomycin was empirically administered in adult patients under 65 years of age with CLcr ≥ 60ml/min, the therapeutic trough range was not achieved depending on the age and the renal function, suggesting that CPCS is vital in the dose adjustment for the drug in the patient group.