Vancomycin TDM 유용성 평가

초록

The therapeutic concentration maintenance of vancomycin has become an important concern due to emergence of vancomycin-intermediate and vancomycin-resistant Staphylococcus aureus, and it can be achieved through therapeutic drug monitoring (TDM) service. This study was designed to evaluate the usefulness of TDM service in Korean patients. Patients received TDM service between December 2002 and February 2005 in Korea University Anam Hospital were categorized into four groups. Three of these groups were based on modified doses of vancomycin after TDM service: group A, B and C had ＞ 2 g/day, 2 g/day and ＜ 2 g/day, respectively, and patients on dialysis belong to the fourth group D. Each group was evaluated in accordance with the guidelines suggested by Korean Society of Infectious Diseases and Korean Society for Chemotherapy. These guidelines that encourage TDM service include concomitant therapy with nephrotoxic agents, high dose vancomycin therapy, unstable renal function, dialysis, central nervous system infection, serious disease and neonate. Total 702 patients (412 males, 290 females, average 55.96 ± 16.97 years in age, 60.37 ± 11.37 kg in weight and 12.56 ± 11.23 days in vancomycin use) were retrospectively reviewed. The rate of group A who satisfied the guidelines was 58.7%(74/126): group B, 53.8%(120/223); group C, 76.0%(219/288); group D, 100%(65/65). 68.1%(478/702) of all patients satisfied the guidelines, and 68.2%(479/702) of patients were r ecommended to modify vancomycin dose. The number of patients who met the guidelines or were recommended to modify vancomycin dose reached 85.3%(599/702) and, it can be concluded that TDM service is useful in majority of patients receiving vancomycin therapy.

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