Augmented Renal Clearance of Vancomycin in Hematologic Malignancy Patients

• Published in: Biological & pharmaceutical bulletin Vol. 42; no. 12; pp. 2089 - 2094
• Main Authors: Izumisawa, Tomohiro, Kaneko, Tomoyoshi, Soma, Masakazu, Imai, Masahiko, Wakui, Nobuyuki, Hasegawa, Hideo, Horino, Tetsuya, Takahashi, Noriko
• Format: Journal Article
• Language: English
• Published: Japan The Pharmaceutical Society of Japan 01.12.2019; Pharmaceutical Society of Japan; Japan Science and Technology Agency
• Subjects: Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents - pharmacokinetics; Antibiotics; Bayesian analysis; Blood cancer; Blood levels; Drug Monitoring; Female; hematologic malignancy; Hematologic Neoplasms - drug therapy; Humans; Japan; Male; Malignancy; Metabolic Clearance Rate; Middle Aged; Multiple regression analysis; non-malignancy; Pharmacokinetics; Retrospective Studies; Side effects; Vancomycin; Vancomycin - administration & dosage; Vancomycin - blood; Vancomycin - pharmacokinetics; Japan; pharmacokinetics; vancomycin; hematologic malignancy; non-malignancy
• ISSN: 0918-6158; 1347-5215
• DOI: 10.1248/bpb.b19-00652

The pharmacokinetics of vancomycin (VAN) was retrospectively examined based on trough concentrations at large scale to identify pharmacokinetic differences between Japanese hematologic malignancy and non-malignancy patients. Data from 261 hematologic malignancy patients and 261 non-malignancy patients, including the patient’s background, VAN dose, and pharmacokinetics of VAN estimated by an empirical Bayesian method, were collected and analyzed. Our results showed significantly higher values for VAN clearance and shorter elimination half-lives in patients with hematologic malignancies than non-malignancy patients. In addition, multiple regression analysis under adjusting for confounding factors by propensity score, showed that VAN clearance significantly increased in relation to hematologic malignancies. In conclusion, since in hematologic cancer patients VAN clearance is increased, the blood concentration of VAN becomes lower than expected and this may contribute to the survival of resistant bacteria when VAN is administered at low doses. These results suggest that early monitoring of VAN levels in hematologic cancer patients might be recommended to maintain desired effects without side-effects.