バンコマイシン初回負荷投与における腎機能低下および正常患者に関する安全性の比較検討

抄録

The revised TDM Clinical Practice Guidelines for Antibiotics published in February, 2022 recommend administering a loading dose of vancomycin (VCM) to patients with renal impairment (eGFR <80 (mL/min/1.73m²)). Herein, we investigated the efficacy and safety of administering a loading dose of VCM to our patients with an eGFR <80 compared with those with an eGFR ≥80. The nomogram of our hospital specifies VCM loading doses of 1 g and 1.5 g for body weights <55 kg and ≥55 kg, respectively. The maintenance dose was set to a fixed value for each creatinine clearance value (mL/min). Renal dysfunction was not detected in the eGFR <80 group (n = 59) compared with an incidence of 9.0％ in the eGFR ≥80 group (n = 11). The incidence of acute kidney injury did not significantly differ between groups (8.4％, eGFR <80 group; 9.0％, eGFR ≥80 group). The average value of the initial VCM trough concentrations did not significantly differ between groups (10.8 ± 4.1 μg/mL, eGFR <80 group; 10.6 ± 3.8 μg/mL, eGFR ≥80 group). These results indicate that administering a loading dose of VCM to patients with renal impairment (eGFR <80) is safe. The loading dose may be appropriate in this study.