The Scottish model of vancomycin dosing and therapeutic drug monitoring improves both efficacy and safety of vancomycin therapy

Česká verzia

Authors: Kristýna Zahálková ¹; Aleš Chrdle ^1,5; Olga Dvořáčková ²; Marie Kašparová ³; Magdalena Horníková ⁴; Václav Chmelík ¹
Authors place of work: Infekční oddělení Nemocnice České Budějovice, a. s. ¹; Ústav laboratorní diagnostiky a veřejného zdraví Zdravotně sociální fakulty Jihočeské univerzity v Českých Budějovicích ²; Laboratoř klinické chemie, hematologie a imunologie Nemocnice České Budějovice, a. s. ³; Pracoviště bakteriologie Laboratoře lékařské mikrobiologie Nemocnice České Budějovice, a. s. ⁴; Tropical and Infectious Disease Unit, Royal Liverpool University Hospital, Liverpool, Velká Británie ⁵
Published in the journal: Vnitř Lék 2018; 64(7-8): 717-724
Category: Original Contributions

Summary

Objective: Vancomycin therapeutic drug monitoring (TDM) is recommended for better treatment efficacy and safety. The Scottish Antimicrobial Prescribing Group model recommends weight-based loading dose, next 3–4 doses based on creatinine clearance and maintenance doses according to trough concentrations. Methods: Retrospective cohort study of all adult patients treated with vancomycin before and after introducing the guideline in a large Czech hospital in 2015 compares the success rate in achieving recommended trough concentrations (10–20 mg/l) during first measurement and efficiency of maintaining these concentrations subsequently. Assessment of vancomycin related nephrotoxicity is included. Results: In 2014, 74/163 (45.4 %) patients achieved recommended concentrations in the first measurement, compared to 101/160 (63.1 %) patients in 2016 (χ²; p = 0.001). Recommended trough concentrations in more than half of subsequent measurements were detected in 51/105 patients (48.6 %) in 2014 and in 80/117 patients (68.4 %) in 2016. Not a single level in subsequent measurements within the range was detected in 28 (26.7 %) cases in 2014 and in 10 (8.5 %) cases in 2016 (Mann-Whitney; p = 0.026). There was no difference in nephropathy occurrence (χ²; p = 0.286). Conclusion: The adopted Scottish model of vancomycin TDM resulted in very significantly higher achievement of recommended trough concentrations during first measurements and significantly more effective maintenance of subsequent concentrations, without increased nephrotoxicity. Key words: guideline – therapeutic drug monitoring – vancomycin

Zdroje

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