Comparative Examination of the Initial Dosage Setting of Vancomycin Therapy in the Adult MRSA Patients

• Published in: Iryo Yakugaku (Japanese Journal of Pharmaceutical Health Care and Sciences) Vol. 28; no. 6; pp. 530 - 540
• Main Authors: Teramachi, Hitomi, Hatakeyama, Hiromi, Matsushita, Ryo, Imai, Yukio, Miyamoto, Ken'ichi, Tsuji, Akira
• Format: Journal Article
• Language: Japanese; English
• Published: Japanese Society of Pharmaceutical Health Care and Sciences 2002
• Subjects: dose interval; initial dosage; nomogram; therapeutic drug monitoring; vancomycin
• ISSN: 1346-342X; 1882-1499
• DOI: 10.5649/jjphcs.28.530

The department of pharmacy which is a member of the Infection Control Committee in Kouseiren Chu-nou Hospital provided a systematic program of vancomycin (VCM) therapeutic drug monitoring (TDM) and consultations regarding the suitable dose and administration interval etc. of VCM for both patients and physicians. However, in many cases the initial dosage and dose interval were empirically decided by the physician. In the present study, we retrospectively examined three nomogrames that were recommended as the rough standard for determining the initial dosage and dose interval, in comparison to the Bayesian method, based on our hospital data collected from adult MRSA patients. We also compared our findings with the Moellering's method, Matzke's method, Maeda's method and the Population mean methods. Maeda's method did not predict the serum trough and peak levels that reach poisonous ranges. Maeda's method was found to be a safe method. In addition, Maeda's method was found to reach the therapeutic ranges the most frequently of the four methods. Furthermore, the calculations for Maeda's method were simpler than the other three methods. Accordingly, it is possible to easily calculate the initial dosage and dose interval in the clinical field. The serum VCM concentrations should thus be measured for each patient, as soon as possible, to correct the dosage using the Bayesian forecasting technique, because the therapeutic ranges sometimes deviate from the predicted range.