バンコマイシン初期投与設計の検討

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We have frequently experienced the lack of correspondence of vancomycin dosages noted on the manufacturer's sheet and the dosage given for renal dysfunction in interview form with the actual dosage. Accordingly, we investigated retrospectively to determine and to estimate via several methods, the initial dosage and dose interval of vancomycin based on renal function, age and body weight. With regard to renal function, dosages estimated by Moellering et al. and by Nielsen et al. greatly differed from that determined by the one-compartment model individualized method. Furthermore, the dose interval estimated by Lake-Peterson's method was significantly different from that generated by individualized method, whereas that derived by Matzke's method did not significantly differ. The indivdualized method produced the most precise prediction follwed in order by Matzke's method and Moellering's method. The elimination rate constant (Kel) and dose interval significantly contracorrelated and correlated with the age in all patients as well as in patients presenting normal renal function and mild renal dysfunction. Thus, for elderly patients, the dose interval should be longer than that for younger patients even if they were not complicated with renal dysfunction. Body weights significantly correlated with vancomycin dosages, specifically indicating that the dosage should be estimated by body weight. As actual body weight did not differ from ideal body weight in our investigtion, the dosage/actual body weight and dosage/ideal body weight expressed almost the same values. This investigation confirmed that initial vancomycin therapy must be determined by body weight. Moreover, for renal dysfuncion patients, Matzke's method should be recommended over those of Moellering, Nielsen and Lake-Peterson. Finaly, the dose interval should be longer for elderly patients than for younger patients.
日本医療薬学会の論文
1994-12-20

バンコマイシン初期投与設計の検討

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