Clinical pharmacy and serum concentration of Vancomycin: from therapeutic monitoring to change of conduct in inpatient units
Keywords:therapeutic monitoring, vancomycin; tenal replacement therapy.
Objective: To compare, by means of plasma concentration, the prescribed dose (loading dose and full dose) of vancomycin in patients undergoing hemodialysis at Hospital Santa Casa de Misericordia in Maringa. Method: Retrospective cohort study with patients hospitalized from July/2020 to July/2021 who were on renal replacement therapy and used vancomycin. Data were collected from the electronic medical record considering the serum concentrations and clinical information of the patients, being organized in spreadsheets and the comparison of the medians of the two groups performed by the statistical tests of Mann-Whitney and Kruskal- Wallis. Result: A total of 51 patients were included in the study, 13 who received a mean loading dose of 19.01 mg/kg and 38 patients with full dose (1,000mg every 8 - 12h) before adjustment for dialysis, with median aged 55 years and 64.5 years, respectively. The amount of pharmaceutical adjustments performed, considering the serum concentration and the number of vouchers performed, were similar in both groups. The first trough obtained was statistically lower in patients with a loading dose (20 μg/mL) when compared to a full dose (33.2 μg/mL). Furthermore, the full dose group presented about 60% of the results of vouchers, during treatment, above the recommended therapeutic range. It was not possible to assess therapeutic failure and patient survival. Conclusion: Patients who received a loading dose reached the therapeutic serum level of vancomycin more quickly and with a lower risk of toxicity, remaining within the target during the entire treatment.
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