夜勤時におけるバンコマイシン初期投与設計体制の確立とその成果

Abstract

Although accumulated evidence has shown the usefulness of the initial dosing setting for vancomycin, a gap exists between evidence and clinical practice, particularly in the night shift. The aim of this study was to fill the evidence-practice gap by using a newly developed procedure manual for planning the vancomycin dosing schedule and verifying the impact of the implementation of the initial dose setting for vancomycin. Twenty-five patients received an individual dose regimen using the present procedure (intervention group) and 23 patients who were taking the conventional dose by prescriber (non-intervention group) were enrolled in this study. Median (interquartile range: IQR) vancomycin serum trough concentration after 3 days of treatment was 12.1 μg/mL (10.1-15.3) for the intervention group, 9.5 μg/mL (5.6-15.0) for the non-intervention group. Clinical efficacy after 3 days of treatment was significantly superior in the intervention group(P = 0.004). Furthermore, the duration for 50% reduction of C-reactive protein and the duration for the reduction in body temperature to < 37°C were significantly shorter in the intervention group as compared with those in the non-intervention group. The incidence of vancomycin-induced nephrotoxicity tended to be lower (P = 0.24) in the intervention group than in the non-intervention group (0% versus 9%). In addition, the rate of initial dose setting in the night shift was significantly elevated after intervention (0% versus 70%, P < 0.001). These findings suggest that the present implementation system was useful for promotion of initial dose setting for vancomycin and improvement of patient's outcome.