| Autor: |
Keshavarzi, Fazlollah, Nadaraja, Vithyah, Alias, Aliza, Farrukh, Muhammad Junaid, Chuan Sheng Yap |
| Předmět: |
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| Zdroj: |
Indonesian Journal of Pharmacy / Majalah Farmasi Indonesia; 2022, Vol. 33 Issue 3, p484-492, 9p |
| Abstrakt: |
Recently published Infectious Diseases Society of America (IDSA) guidelines on vancomycin dosing no longer advocates the use of trough concentrations as surrogate markers for clinical efficacy. Protocols developed prior to revised targets may not reflect to the true efficacy marker for vancomycin that is area under the curve divided by minimum inhibitory concentration (AUC/MIC) 400-600 mg.hr/L. This study aimed to evaluate the local vancomycin dosing protocol in achieving the target trough concentration and extrapolated AUC/MIC of 400-600 mg.hr/L in patients with haemodialysis. A retrospective analysis of therapeutic drug monitoring forms and individual medical records of hemodialysis patients was conducted. Vancomycin AUC of each individual was extrapolated via the use of a pharmacokinetic modelling software, PrecisePK®. Chi-square test of independence was used to determine the association of factors affecting AUC/MIC. A p value of less than 0.05 was considered statistically significant. A total number of 80 hemodialysis-dependent cases who were on vancomycin were recruited. More than 62% of hemodialysis patients showed AUC/MIC > 800 mg.hr/L. AUC/MIC was heavily influenced by minimum inhibitory concentration of the infecting microorganism. Exclusive trough-guided dosing may not translate well in achieving clinical efficacy of vancomycin in hemodialysis patients. The observed small values of MIC account for large AUC/MIC. Adjusting the dose to achieve AUC/MIC of 400 -- 600 mg.hr/L requires a lower dose of vancomycin in almost 80% of the cases. The clinical impact of this dosage revision should be investigated to ensure that vancomycin efficacy will be maintained. If vancomycin efficacy is preserved, the reduced dose would be helpful to maintain the residual kidney function; a factor which is associated with overall mortality of HD patients. [ABSTRACT FROM AUTHOR] |
| Databáze: |
Complementary Index |
| Externí odkaz: |
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