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Evaluation of Efficacy and Safety Depending on the Vancomycin Trough Level
J. Kor. Soc. Health-syst. Pharm. 2020;37:459-470
Published online November 30, 2020;  https://doi.org/10.32429/jkshp.2020.37.4.005
© 2020 Korean Society of Health-System Pharmacists

Ji Won Kima,†, Young Seo Kima, Hirata Sa, Ji Hye Junga, Ji Eun Kwona, Jeong Yi Yoona, Eyn Young Kwona, Shin Yi Hwangboa and Dong Gun Leeb

Department of Pharmacy, Seoul St. Mary’s Hospital, The Catholic University of Koreaa
Department of Infectious Diseases, Seoul St. Mary’s Hospital, The Catholic University of Koreab 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
Correspondence to: 김지원 Tel:02-2258-2545 E-mail: jiwonk@cmcnu.or.kr
Received June 17, 2020; Revised August 10, 2020; Accepted October 21, 2020.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Background : A recently published review on the therapeutic monitoring of the vancomycin has recommended maintaining the vancomycin trough concentration at 15-20 mg/L for severe infections caused by methicillin-resistant Staphylococcus aureus. Additionally, in Seoul St. Mary’s Hospital, the vancomycin trough concentrations above 15 mg/L are increasingly recommended for therapeutic outcome. The purpose of the study was to analyze the efficacy and safety according to the vancomycin trough concentration and to apply the trough concentration in clinical trials.
Methods : A retrospective analysis was conducted among patients age 18 and older detected Gram-positive cocci at Seoul St. Mary’s Hospital and received vancomycin for three days or more October 2018-May 2019. The patients were stratified by the mean vancomycin trough concentration [T1 (<15 mg/L), T2 (≥15 mg/L)]. To evaluate the efficacy, we assessed the rate of the two consecutive growth-negative blood cultures and the mean of the c-reactive protein (CRP) change. The safety was evaluated through the percentage of the serum creatinine (SCr) and blood urea nitrogen (BUN) levels exceeding normal range after administration.
Results : Of the 89 patients, 72 patients were in T1. The mean trough concentration of the vancomycin was 9.0±3.0 mg/L in T1 and 19.5±7.2 mg/L in the T2 (p<0.001). The T2 showed significantly higher rates of the two consecutive growth-negative blood cultures which were 58.8% of T2 and 26.4% in the T1 (p=0.014). The CRP change was not significantly higher in the T2 (p=0.577). The proportion of the SCr and BUN beyond the normal range after the vancomycin administration was not statistically significant different (p=0.251, p=0.154).
Conclusion : The patients with the mean trough concentration of the vancomycin higher than 15 mg/L had significantly higher rates of the two consecutive growth-negative blood cultures, and there was no significant difference in the incidence of renal toxicity. Thus, increasing the vancomycin trough concentration to 15 mg/L or higher could enhance the therapeutic effect without significant increase in the nephrotoxicity.
Keywords : Vancomycin, Vancomycin trough concentration, TDM, Nephrotoxicity


November 2020, 37 (4)