抄録
The purpose of this study is to develop an accurate and reliable nomogram of vancomycin hydrochloride (VCM) for the treatment of patients with different renal functions.
A VCM dosage regimen was proposed based on a nomogram derived from the population pharmacokinetic parameters of VCM and the creatinine clearance function of each patient, in combination with the Bayesian method, namely, a vial of VCM (equivalent to 0.5g of VCM) was taken as a unit to determine the initial dose and the dosage interval set at a 12-hourly or daily basis.
One hundred and two patients admitted to the Kumamoto Red Cross Hospital between February, 2000 and September, 2001, who were found to have acquired methicillin-resistant Staphylococcus aureus (MRSA) infection, were treated with VCM. The usefulness of the proposed nomogram was then retrospectively evaluated by using the routine therapeutic drug monitoring data of these patients by assuming that the patients were treated according to the proposed regimen, and next the steady state serum concentrations of VCM were predicted by the Bayesian method. The predictability of the proposed nomogram, namely, the percentage of achieving therapeutic levels of VCM (the concentration 1 hour after infusion : 25-40μg/mL and the trough concentration : 5-12μg/mL), was significantly greater than that of commonly used Matzke's method after slight modification. Thirty-one MRSA patients were actually treated based on the proposed regimen between October, 2001 and January, 2002, and 58%of these patients' serum concentrations of VCM were found to have successfully achieved a level within the therapeutic windows of VCM.
We concluded the proposed nomogram to be useful for determining the appropriate initial dosage regimens for VCM, especially when treating MRSA infected patients with various degrees of renal function.
