Vol.67 No.1 January 2019

Risk factors for high trough values of vancomycin hydrochloride

Akihide Fujii^{1, 3)}, Seiko Kitagawa^{1, 3)}, Satoshi Kaya¹⁾, Hideyuki Sumida¹⁾, Yoshie Doi¹⁾, Tomiko Katsumura¹⁾, Youko Ninomiya¹⁾, Yutaka Kouguchi^{2, 3)}, Masami Ishimatsu^{2, 3)}, Masayo Tamura^{2, 3)}, Sanae Hirata^{3, 4)}, Tomohiro Oishi^{3, 5)} and Kihei Terada^{3, 5)}

¹⁾Department of Pharmacy, Kawasaki Medical School Hospital, 577 Matsushima, Kurashiki, Okayama, Japan
²⁾Department of Central Laboratory, Kawasaki Medical School Hospital
³⁾Division of Infection Control and Prevention, Kawasaki Medical School Hospital
⁴⁾Department of Nursing, Kawasaki Medical School Hospital
⁵⁾Department of Pediatrics, Kawasaki Medical School Hospital

Abstract

Therapeutic drug monitoring (TDM) of vancomycin hydrochloride (VCM) is an important task of pharmacists to ensure safe and effective pharmacotherapy, and there are often cases with unexpectedly high trough levels. From February 2014 to June 2016, patients who underwent TDM for VCM at Kawasaki Medical School Hospital showed trough values of more than 25 μg/mL (high value group; n=28) or more than 10 μg/mL, but less than 20 μg/mL (target value group; n=101) for 7 days or more (pediatric patients and dialysis patients were excluded). Univariate analysis revealed significant differences between the two groups in the degree of renal dysfunction, after-completion-of-administration creatinine clearance (Ccr), use/non-use of furosemide dose, presence/absence of pleural effusion, after-completion-of-administration creatinine (Cr), TDM simulation rate, administration period, use/non-use of aminoglycosides, concomitant administration of drugs affecting renal function, and age. Multiple logistic regression analysis identified "use/non-use of furosemide" p=0.00027 (odds ratio 10.5) and "use/non-use of aminoglycosides" p=0.01 (odds ratio 7.40) as statistically significant factors. "Use/non-use of furosemide" is a particularly important factor influencing the trough values, and patients taking "furosemide" should also receive TDM in consideration of the pharmacokinetics not only relying on the implementation of TDM using simulation software but also refer to this study, that when diuretics such as furosemide were used, we began measuring blood concentration more frequently and also have dosage consultation earlier than before.

Key word

vancomycin hydrochloride, trough value, risk factor, therapeutic drug monitoring, furosemide

Received

December 28, 2017

Accepted

July 19, 2018

Jpn. J. Chemother. 67 (1): 51-56, 2019