Vancomycin use and monitoring in adult patients with chronic osteomyelitis of the long bones
- نوع فایل : کتاب
- زبان : انگلیسی
- مؤلف : Chin-En Chen Cheng-Chung Pan Jih-Yang Ko
- چاپ و سال / کشور: 2010
Description
Background Vancomycin is the treatment of choice for oxacillin-resistant Staphylococcus aureus (ORSA) infections in long bones. However, an inappropriate dosage of vancomycin may result in toxicity or treatment failure. Materials and methods In this study, 21 patients infected with ORSA were treated with intravenous vancomycin. The concentration of serum vancomycin was measured by fluorescence polarization immunoassay. The erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were also measured at each blood sampling. Results When vancomycin doses were given based on the manufacturer’s recommendations, 46% (39/84) of the patients were found to have inappropriate blood levels. After the dose of vancomycin was then adjusted, at the third blood sampling, a higher percentage of adequate peak and trough serum vancomycin concentrations were found. There was no statistical difference in peak or trough levels produced by intravenous doses of vancomycin of 500 mg given every 6 h or 1,000 mg given every 12 h. However, initial dosing of 1,000 mg every 12 h may be a better choice than 500 mg every 6 h for younger patients. The CRP was significantly decreased (P\0.01) at the time of the second blood sampling during vancomycin treatment. Conclusions The data from this study suggest that peak and trough vancomycin concentrations should be monitored for patients who have chronic osteomyelitis and prolonged vancomycin treatment. Further studies may help resolve whether such monitoring beneficially affects outcomes and health care costs
Eur J Orthop Surg Traumatol (2011) 21:27–32 DOI 10.1007/s00590-010-0652-2 Received: 16 January 2010 / Accepted: 3 May 2010 / Published online: 6 June 2010
