バンコマイシン初回投与設計時における新規日本人向けＧＦＲ推算式の評価―Ｃｏｃｋｃｒｏｆｔ＆Ｇａｕｌｔ式との比較―

Abstract

TDM based on serum vancomycin concentrations aids individual dosage design for patients with MRSA infections.In addition,the initial dose needs to be set appropriately to improve the effects of treatment and ensure safety.Since vancomycin clearance is correlated with creatinine clearance,a precise evaluation of creatinine clearance is required for setting initial doses of vancomycin.A new equation for estimated GFR (eGFR) was reported by the Japanese Society of Nephrology in 2009.In the present study,we investigated the predictability of the relationship between creatinine clearance and eGFR,initial dose setting for vancomycin using the eGFR equation,and compared the predictive performance of the vancomycin concentration estimated by the Cockcroft & Gault (CG) equation with that of the eGFR equation.Although eGFR was well correlated with creatinine clearance,eGFR tended to be lower than the creatinine clearance as eGFR became higher.The predictive concentration of vancomycin using the eGFR equation and CG equation were biased positively in all patients.When the patients were divided into 4 groups based on age and renal function,the accuracy of prediction using the eGFR equation was significantly better than that for the CG equation in patients more than 70 years old -with eGFR<60 mL/min.This result suggested that the eGFR equation would be more useful for determining the initial dose setting of vancomycin in elderly patients with a decline in renal function.