投与間隔設定用ノモグラムを利用したバンコマイシンの処方適正化と添付文書記載内容の検討

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To elcidate the factors leading to hindrance for the rationalization of dosage regimen of vancomycin (VCM), its therapeutic drug monitoring (TDM) data obtained from 64 patients were reviewed. and the utility of a nomogram method to determine the daily dosage of VCM (Nomogramv^<Does>) described in the package insert of VCM injection was examined in comparison with another nomogram method to determine the dosing interval (Nomogram^<Int>) which was reported by Matzke et al. Before starting the dosage regimen. the serum peak and trough levels of VCM in the almost patients deviated from their therapeutic ranges (peak. 25-40 μg/ml ; trough, ≦ 10μg/ml), because the uniform dosage based on the descriptions in the package insert were performed for the patients with various degrees of renal functions. The after dosage regimen by using Nomogram^<Int>, the serum peak and trough levels of VCM in the subjects were controlled within their therapeutic ranges as a result of the uniform dosing interval of 8 or 12 hours in the early step of dosing were corrected to l 8-56 hours according to the values of creatinine clearance (CLcr) in the patients. On the other hand. the serum level of VCM was poorly controlled within its therapeutic ranges after starting the dosage regimen by using a Nomogram^<Dose> , because the nomogram provided only the daily dose but not the optimum dosing interval. To aleat all physicians to the problem of the dosage regimen of VCM. a letter including these results was thus distributed to all wards in our hospital. Thereafter, the percentage of well controlled subjects. in the early dosage step increased to about 10-fold which was about as much as that before the information was disseminated. Based on the present results we strongly recommend the package descriptions inside VCM package should thus be revised for adoption in clinical practice.
1997-06-10

投与間隔設定用ノモグラムを利用したバンコマイシンの処方適正化と添付文書記載内容の検討

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