Therapeutic monitoring of vancomycin

Maria Luiza Pereira Alves,Paula Nishiyama,Sergio Seiji Yamada,Gessilda Alcantara Nogueira De Melo

doi:10.4025/actascihealthsci.v34i2.10617

Maria Luiza Pereira Alves, Paula Nishiyama + Show 2 more

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https://doi.org/10.4025/actascihealthsci.v34i2.10617

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Abstract

The present study aimed to characterize admitted patients in a public hospital in the Northwestern region of Parana State, which were subject to therapeutic monitoring of vancomycin during 2007 and 2008. The data were obtained by a retrospective study of patients' medical records, from where we separated the laboratory results, medical prescriptions, gender, age, and diagnosis of patients submitted to therapeutic monitoring. Of the total of 38 patients, only eight (21.1%) presented serum concentrations within recommended range, varying from 1.3 to 47.9 mg L -1 . Concentrations above the reference value were observed in 22 patients (57.9%), and below the reference, in other eight patients (21.1%). The recommended serum concentrations at peak were obtained in only four patients (11.4%), higher than the recommended value in seven patients (20.0%), and lower, in 24 patients (68.6%). Only one patient (2.6%) presented serum concentration within the reference values at both high and low dosages. Therefore, the results evidenced the importance of therapeutic monitoring of vancomycin, individualizing the dose for each patient, and reducing toxic or subtherapeutic effects of this antimicrobial substance.

Highlights

Vancomycin is soluble and complex tricyclic glycopeptide antibiotic, obtained from Streptococcus orientalis, with bacteriostatic action against grampositive cocci and bacilli (HAMMETT-STABLER; JOHNS, 1998)
Because of the need and importance of using the vancomycin in several disease states, the goal of this study was to perform a characterization of the patients, hospitalized in a public hospital located in Northwestern region of Paraná State, subjected to therapeutic monitoring of vancomycin in the years 2007/2008, as well as of the results of the laboratory analysis of these patients
This study is result of the analysis of medical charts of patients hospitalized in a public hospital located in Northwestern region of Paraná State, subjected to therapeutic monitoring of vancomycin in the period of 2007 and 2008

Summary

Introduction

Vancomycin is soluble and complex tricyclic glycopeptide antibiotic, obtained from Streptococcus orientalis, with bacteriostatic action against grampositive cocci and bacilli (HAMMETT-STABLER; JOHNS, 1998). Its use is indicated for the treatment of infections caused by staphylococci or other betalactam resistant gram-positive bacilli, in patients allergic to penicillin or who have not responded to treatment with other drugs, including penicillins or cephalosporins. It is predominantly used for the treatment of methicilin-resistant staphylococcal. Health Sciences infections, such as brain abscess, staphylococcal meningitis, peritonitis associated with continuous ambulatory peritoneal dialysis, and sepsis It is used isolated or combined with aminoglycosides in the treatment and prophylaxis of endocarditis, as prophylaxis in patients subjected to surgical procedures and in the treatment and management of immunocompromised patients (LOPES, 2007; MARTINDALE, 2009). All species of gram-negative bacilli and of mycobacteria are resistant to vancomycin (CUNHA; RISTUCCIA, 1983)

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