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Comparison of Measured Trough Values after Deriving the Initial Dose Setting of Vancomycin with a Conventional Computer Software and a Nomogram Based on the Revised Japanese 2016 Therapeutic Drug Monitoring Guidelines for Antimicrobial AgentsDOI: 10.4236/pp.2018.911037, PP. 481-487 Keywords: Therapeutic Drug Monitoring (TDM), Vancomycin (VCM), Estimate Glomerular Filtration Rate (eGFR), Guideline 2016 (GL2016), Computer Software Abstract:
Background: Due to the relatively high
renal toxicity of vancomycin injection (VCM), setting an initial dose that
achieves a trough that ranges between 10 and
20 μg/mL on day 3 is important to ensure safety and minimize side-effects, especially
for patients with low renal function. To address these issues, the revised 2016 Therapeutic Drug Monitoring
(TDM) Guidelines for Antimicrobial Agents (GL2016) proposed the use of a renal
function-based, estimate glomerular filtration rate (eGFR) nomogram for setting
the dose of VCM in Japan. Methods: Our hospital introduced the use of the GL2016 in September 2016 for the
patients administered VCM. After setting the initial VCM dose using 1) a conventional VCM analysis software and 2) the GL2016 eGFR nomogram, the measured trough values on day 3 were
compared and evaluated in this study. Results:
With the VCM analysis software, the mean measured trough value in the a-total group (n = 53) was 12.8 ± 4.7
μg/mL. With the eGFR nomogram, the mean measured trough value in the b-total
group (n = 13) was 9.6 ± 4.6 μg/mL. However, when the different severities of
renal function were compared, the mean measured trough value was more
significantly lower in the b-1 group than in the a-1 group among subjects with
G2 and above (eGFR ≥ 60 mL/min/1.73 m2),
but it was similar between the a-2 group and the b-2 group among subjects with
G3 and below (eGFR < 60 mL/min/1.73 m2).
The proportion of subjects reaching the various trough ranges shows similar
tendency. Conclusions: These
data suggested that the measured trough value on day 3 was generally lower when
the initial dose was
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