Individualization of vancomycin therapy.
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Accession number;00A0771319
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| Title;Individualization of vancomycin therapy. |
| Author;
IGARASHI MASAHIRO
(Fed. of Natl. Public Serv. and Affil. Personnel Mutual Aid Assoc., Toranomon Hosp.)
NAKATANI TATSUO
(Fed. of Natl. Public Serv. and Affil. Personnel Mutual Aid Assoc., Toranomon Hosp.)
HAYASHI MASAHIRO
(Fed. of Natl. Public Serv. and Affil. Personnel Mutual Aid Assoc., Toranomon Hosp.)
NAKATA KOICHIRO
(Fed. of Natl. Public Serv. and Affil. Personnel Mutual Aid Assoc., Toranomon Hosp.)
KASUYA YASUJI
(Tokyo Coll. of Pharm., Fac. of Pharm. Sci.)
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Journal Title;Japanese Journal of Chemotherapy
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Journal Code:F0608A
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ISSN:1340-7007
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VOL.48;NO.7;PAGE.545-552(2000)
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| Figure&Table&Reference;FIG.7, TBL.3, REF.16 |
| Pub. Country;Japan |
| Language;Japanese |
| Abstract;This study describes a pharmacokinetic approach to safe and effective treatment with vancomycin (VCM), an antibiotic used for infections caused by methicillin-resistant Staphylococcus aureus (MRSA). Therapeutic drug monitoring was performed in 22 patients (April 1995-February 1999) with various degrees of renal functional impairment. The serum concentrations of VCM were measured at steady state, immediately before (trough), and 2 hours after (peak), intravenous infusion. The initial VCM doses for 15 non-dialysis patients were determined by using Moellerin's nomogram. At these initial doses, none of the patients had VCM levels in the toxic range. Among these 15 patients, the trough levels of 12 patients and the peak levels of 2 patients were within the therapeutic range (trough: 5-15 .MU.g/mL, peak: 20-40 .MU.g/mL) . There were 5 patients whose initial VCM dosage needed to be adjusted for effective treatment. Pryka's population pharmacokinetic parameters and a simple one-compartment model were used to calculate the patients' pharmacokinetic parameters by the Bayesian method to adjust the dosage. The dosage was appropriately, adjusted 4 patients had trough levels, and 4 patients had peak levels, within the therapeutic range. The Bayesian method accurately predicted the actual VCM concentrations. At the trough level (n=9) the mean prediction error (ME) was -1.83 .MU.g/mL, the mean absolute prediction error (MAE) was 2.14 .MU.g/mL, the root mean squared prediction error (RMSE) was 2.79 .MU.g/mL, and at the peak level (n=9) the ME was 2.01 .MU.g/mL, the MAE was 3.70 .MU.g/mL, and the RMSE was 5.22 .MU.g/mL. Four patients on dialysis received an initial VCM dose of 15 mg/kg/week, and the dosage of two patients was adjusted by using the Sawchuk-Zaske method. Efficacy of VCM treatment was recognized in 83% of the patients, and there was no renal impairment caused by VCM.... (author abst.) |
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