Therapeutic Drug Monitoring of Vancomycin: The Relationship Between Trough Plasma Concentration and Creatinine Clearance

Mohammad Ali Salahshoor,Katayoun Derakhshandeh,Masoumeh Kurd,Sara Ataei,Omid Heidary Shayesteh,Abbas Taher

doi:10.34172/ajpr.2020.09

Abstract

Background: In this study which was conducted in Besat hospital (Hamadan, Iran), the therapeutic drug monitoring (TDM) of vancomycin (VAN) was carried out based on the quantification of VAN trough in intensive care unit (ICU) patients. Methods: The study population was selected from ICU patients treated by intravenous VAN. To determine VAN trough, blood samples were taken from patients before the fourth dose. Then, trough concentrations were determined by newly developed high-performance liquid chromatography (HPLC) and compared with the conventional method of immunoassay. Twenty patients were included based on the aim of the study. Results: The mean value of the trough for the studied patients was 26.31±18.05 μg/mL. For 16 (80%) patients, trough levels were found to be less than 10 μg/mL. For 12 (60%) patients, creatinine clearance was less than 90 mL/min and more than 120 mL/min. The mean value of creatinine clearance for the studied patients was 95.49± 25.74 mL/min. Based on the results, there was a significant relationship between VAN trough concentration and creatinine clearance (P=0.045). Conclusion: In general, the HPLC method is more sensitive than immunoassay for the determination of VAN in plasma samples. However, VAN dosing based on creatinine clearance is not enough for achieving the goal trough level but measuring the creatinine clearance and trough concentration are considered as vital aspects for the TDM of VAN.

Highlights

Therapeutic drug monitoring (TDM) is a clinical procedure that is used for the optimization of individualized dosage regiments
Selecting VAN dosage based on creatinine clearance is not enough for therapeutic drug monitoring (TDM) and in intensive care unit (ICU) patients, and the importance of TDM in ICU is related to factors such as various diseases, different patients with a wide variety of pharmacokinetic and pharmacodynamics conditions, and drug interactions [3]
The coefficient of variation (CV %), accuracy values were within the acceptable limits (Table 2)

Summary

Introduction

Therapeutic drug monitoring (TDM) is a clinical procedure that is used for the optimization of individualized dosage regiments. The importance of TDM in intensive care unit (ICU) is related to factors such as a wide variety of diseases, different patients with various pharmacokinetic and pharmacodynamics conditions, and drug interactions the monitoring of treatment is necessary at ICU [3]. Selecting VAN dosage based on creatinine clearance is not enough for TDM and in ICU patients, and the importance of TDM in ICU is related to factors such as various diseases, different patients with a wide variety of pharmacokinetic and pharmacodynamics conditions, and drug interactions [3]. In this study which was conducted in Besat hospital (Hamadan, Iran), the therapeutic drug monitoring (TDM) of vancomycin (VAN) was carried out based on the quantification of VAN trough in intensive care unit (ICU) patients.

Methods

Results

Discussion

Conclusion