Resumen de Assessment of the effectiveness of the monitoring of vancomycin in patients undergoing hemodialysis
María Isabel Sierra Torres, María Victoria Gil Navarro, Rosalía Rodríguez Rodríguez, María Dolores Santos Rubio, Francisco Javier Bautista Paloma
Purpose: To assess the effectiveness of monitoring vancomycin in patients undergoing hemodialysis and the interventions made by the Pharmacy Service to reach the therapeutic concentration.
Method: Patients undergoing hemodialysis, whose vancomycin levels were monitored by the Pharmacy Service between May-2012 to April-2013 at a third level hospital, were retrospectively reviewed. Data included: age, sex, weight, residual renal function, type of infection, laboratory cultures, target level, type of dialysis membrane, loading dose, recommended dose, trough level ranges and effectiveness of treatment. The target concentration was between 15-20 μg/mL in serious infections, and 10-15 μg/mL in milder cases.
Results: Data from 26 patients were included but just 24 patients with 25 episodes of treatment were finally accepted. 15 men and nine women, with an average age of 62.5 years and weight between 50-119 kg. From all patients, 10 had residual renal function. Six patients used flow low membrane, eight intermediate, eight high and no data was available in three. The initial dose varied between 5-23 mg/kg. Recommended doses varied between 0.5-2 g. From the total of patients, the target concentration was never reached in five episodes. The goal was achieved after the initial dose in nine cases, after <2 recommendations in four cases, after <5 recommendations in seven cases and five never got it. The infection was solved in 86% of cases.
Conclusions: The efficacy of monitoring vancomycin has been proved with the results, which justifies a broader analysis to establish a treatment-guide with vancomycin in patients undergoing hemodialysis
