• The Korean Journal of Physiology and Pharmacology
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• v.28 no.2
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• pp.121-127
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• 2024

Vancomycin is a frequently used antibiotic in intensive care units, and the patient's renal clearance affects the pharmacokinetic characteristics of vancomycin. Several advantages have been reported for vancomycin continuous intravenous infusion, but studies on continuous dosing regimens based on patients' renal clearance are insufficient. The aim of this study was to develop a vancomycin serum concentration prediction model by factoring in a patient's renal clearance. Children admitted to our institution between July 1, 2021, and July 31, 2022 with records of continuous infusion of vancomycin were included in the study. Sex, age, height, weight, vancomycin dose by weight, interval from the start of vancomycin administration to the time of therapeutic drug monitoring sampling, and vancomycin serum concentrations were analyzed with the linear regression analysis of the mixed effect model. Univariable regression analysis was performed using the vancomycin serum concentration as a dependent variable. It showed that vancomycin dose (p < 0.001) and serum creatinine (p = 0.007) were factors that had the most impact on vancomycin serum concentration. Vancomycin serum concentration was affected by vancomycin dose (p < 0.001) and serum creatinine (p = 0.001) with statistical significance, and a multivariable regression model was obtained as follows: Vancomycin serum concentration (mg/l) = -1.296 + 0.281 × vancomycin dose (mg/kg) + 20.458 × serum creatinine (mg/dl) (adjusted coefficient of determination, R² = 0.66). This prediction model is expected to contribute to establishing an optimal continuous infusion regimen for vancomycin.

• Korean Journal of Clinical Pharmacy
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• v.21 no.3
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• pp.276-279
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• 2011

We report an unusual case of lupus flare induced by intravenous vancomycin in a patient with systemic lupus erythematosus. Due to methicillin resistant staphylococcus aureus in wound culture, intravenous vancomycin was administered to the patient. The patient had been on vancomycin for several days then she experienced fever, malar rash, and vomiting. Based on laboratory results, it was confirmed as lupus flare. Oral prednisolone was given to the patient for symptom control. However, when vancomycin was readministered, the patient had similar symptom to the previous one more intensively. Vancomycin was stopped then the patient became stable. This case report demonstrates that intravenous vancomycin may manifest as lupus flare in patients with systemic lupus erythematosus.

• Archives of Pharmacal Research
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• v.26 no.8
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• pp.638-643
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• 2003

Raw milk samples, and cow and chicken intestines were tested to isolate vancomycin-resistant, gram-positive bacteria. From these samples, we isolated seven vancomycin-resistant Streptococcus equinus, two vancomycin-resistant viridans Streptococcus and two vancomycin-resistant Enterococcus faecium. The MICs of several antibiotics, including vancomycin, against these strains were tested. Seven isolates of S. equinus showed high level resistance to vancomycin and teicoplanin (＞100 $\mu$ g/mL). The cell wall thickness of these strains was compared with that of the sensitive strain by TEM and no differences were obserbed between these strains. We compared the strains of vancomycin-resistant Streptococcus equinus using PCR with Microbial Uniprimer Kit. We concluded that it is necessary to combine other methods in order to cluster and identify all isolates of S. equinus.

• Korean Journal of Clinical Pharmacy
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• v.19 no.2
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• pp.120-130
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• 2009

The objective of this study was to analyze and to improve therapeutic drug monitoring(TDM) service of vancomycin in a local hospital. Patients with TDM service between September 2005 and December 2008 were included and the data were collected for vancomycin use and components of TDM. During that period, 421 cases of TDM service of vancomycin in 236 patients were retrospectively reviewed. The first dosages of vancomycin were appropriate in 135(57.2%) patients and administration of vancomycin was discontinued in 126(53.4%) patients due to therapeutic failure or adverse drug reaction. MRSA was identified in 191(80.9%) patients and 135(70.7%) samples for the identification were sputum. According to the TDM reports, 232(55.1%) serum samples were obtained at the steady-state conditions and 55.5% of the samples that were drawn before the steady-state was due to the physician's inappropriate knowledge about the steady-state. Based on the time of vancomycin administration, 35.8% of the samples were not obtained at the recommended sampling time. For the patients in general wards, the most common reason for the incorrect samples was routine serum sampling by the laboratory medicine phlebotomists between 6 and 8 a.m. except sunday. In contrast, samples drawn by nurses or physicians at inappropriate time were the most common reason for the incorrect samples with patients in the intensive care units. Physicians accepted 68.5% of the recommendations for vancomycin dosage and administration. In conclusion, TDM service of vancomycin needs to be improved in inappropriate sampling time and vancomycin dosage. For solving these problems, current team made of TDM pharmacists and physicians of laboratory medicine can be expanded to include a physician of infectious diseases, nurses and laboratory medicine phlebotomists as new members. Through the TDM service of vancomycin by the new team, we can settle the problems and make the guideline for the scientific controversies associated with therapeutic monitoring of vancomycin.

• Korean Journal of Clinical Pharmacy
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• v.9 no.1
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• pp.35-43
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• 1999

Over the last 50 years, a number of antibiotic agents have been developed and clinically used in the area of infectious diseases. Due to antimicrobial resistance problems and increasing health care costs, the rational use of antibiotics has been required. As a drug of choice to treat infections caused by MRSA, vancomycin has been extensively prescribed since the late 1970's. Recently, reports of vancomycin-resistant organisms such as VRE and VRSA have been increased to draw medical concerns. The objectives of this study were to evaluate the rational use of vancomycin and the appropriateness of the Restrictional Program of Antibiotic Utilization (RPAU) which has been operated at Samsung Medical Center. A retrospective chart review was performed in 132 hospitalized patients treated with vancomycin in the surgery departments from. January to June 1998. The guidelines of ASHP and HICPAC for vancomycin were modified and used as our criteria to determine the vancomycin DUE. In one hundred out of the patients, uses of vancomycin were approved by the Department of Infectious Diseases (DID) based on the RPAU. Vancomycin was appropriately used in $62.5\%$ of the 100 patients according to the criteria of justification of use, while $60.0\%,\;60.0\%,\;79.0\%,\;and\;51.0\%$ of the patients showed appropriate according to those of lab reports such as applicable culture obtained, pretreatment SCr, WBC and serum drug concentration monitoring, respectively. Although the rest 32 patients were not approved to receive vancomycin by the DID, twenty two percent continued receiving vancomycin treatment. This might result from the fact that the RPAU was started not before the use of antibiotics but in the middle of antimicrobial therapy. Continual education should be provide to the related health professionals and the RPAU should be simultaneously modified in order to increase the rate of appropriate uses of antibiotics.

• Korean Journal of Clinical Laboratory Science
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• v.40 no.1
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• pp.6-17
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• 2008

From the total 116,429 clinical specimens submitted to "C" hospital from January 2005 to December 2006, 2,195 strains of streptococci were isolated. Twenty four species of Streptococcus were identified with 0.1~19.8% isolation frequencies, of which S. pneumoniae was 19.8%, S. agalactiae 16.2%, S. anginosus 9.8%, S. constellatus 5.0%, S. oralis 3.9%, S. mitis 3.3%, S. pyogenes 2.7%, S. salivarius subsp. salivarius 2.2%, S. sanguinis 1.9%. For S. pneumoniae, clinical specimens showing over 9.0% isolation rate were 82.8% in sputum, 9.2% in blood, and for Streptococcus species other than S. pneumoniae, 18.0% in sputum, 16.0% in urine and 9.7% in blood. The antimicrobial agents that showed over 90.0% susceptibility were cefotaxime, gatilfloxacin, imipenem, levofloxacin, linezolid, moxifloxacin, rifampin and sporfloxacin in S. pneumoniae, ampicillin, cefotaxime, cetriaxone, levofloxacin, linezolid, penicillin, quinupristin/dalfopristin and vancomycin in S. agalactiae, chloramphenicol, clindamycin, levofloxacin and vancomycin in S. anginosus, levofloxacin, vancomycin in S. constellatus subsp. constellatus, vancomycin in S. oralis, vancomycin in S. mitis, chloramphenicol, clindamycin, levofloxacin, quinupristin/dalfopristin and vancomycin in S. pyogenes, chloramphenicol, levofloxacin and vancomycin in S. salivarius subsp. salivarius, chloramphenicol, levofloxacin and vancomycin in S. bovis II, chloramphenicol, levofloxacin, quinupristin/dalfopristin and vancomycin in S. dysgalactiae subsp. dysgalactiae, levofloxacin, chloramphenicol and vancomycin in the whole group of 10 Streptococcus spp. other than Streptococcus pneumoniae.

• YAKHAK HOEJI
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• v.57 no.1
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• pp.32-36
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• 2013

The purpose of this study was to determine the influence of assay error for improved pharmacokinetic modeling and simulation of vancomycin on the Bayesian and nonlinear least squares regression analysis in 24 Korean gastric cancer patients. Vancomycin 1.0 g was administered intravenously over 1 hr every 12 hr. Three specimens were collected at 72 hr after the first dose from all patients at the following times, at 0.5 hr before regularly scheduled infusion, at 0.5 hr and 2 hr after the end of 1 hr infusion. Serum vancomycin levels were analyzed by fluorescence polarization immunoassay technique with TDX-FLX. The standard deviation (SD) of the assay over its working range had been determined at the serum vancomycin concentrations of 0, 20, 40, 60, 80 and $120{\mu}g/ml$ in quadruplicate. The polynomial equation of vancomycin assay error was found to be SD $({\mu}g/ml)=0.0224+0.0540C+0.00173C^2$ ($R^2=0.935$). There were differences in the influence of weight with vancomycin assay error on pharmacokinetic parameters of vancomycin using the nonlinear least squares regression analysis but there were no differences on the Bayesian analysis. This polynomial equation can be used to improve the precision of fitting of pharmacokinetic models to optimize the process of model simulation both for population and for individualized pharmacokinetic models. The result suggests the improvement of dosage regimens for the better and safer care of patients receiving vancomycin.

• Proceedings of the Korean Society of Applied Pharmacology
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• 1992.05a
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• pp.57-57
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• 1992

Teicoplanin은 actinoplanes teicomyceticus의 발효산물로서 vancomycin과 같은 glycopeptide 계열의 항균제이며, 그 작용기전은 세포벽 합성과정중 peptidoglycan의 중합을 억제하는 것으로 vancomycin과 유사하나 vancomycin과 달리 근육에 주사할 수 있으며 "red man's syndrome"이 생기지 않고 vancomycin보다 반감기가 길다. 그람양성균 감염증에 대한 teicoplanin의 효능 및 안전성을 조사하기 위하여, 그람양성균에 의한 감염증 또는 그람양성균과 그람음성균에 의한 혼합감염증이 확인되거나 의심되었던 환자 46명을 대상으로 teicoplanin과 vancomycin을 투여하였다. 투약 환자중 임상적인 반응을 평가할 수 있는 환자의 수는 vancomycin의 경우 투약환자 22명중 21명, teicoplanin의 경우 24명중 19명이였다. Vancomycin군중 임상적 반응의 평가에서 제외된 1명은 수술 후 흉막강에 MRSA 에 의한 농양으로 투약 29일째에 뇌출혈로 사망하였던 예로, 추적-배양검사에서는 MRSA가 제거 되었다. Teicoplanin군에서는 항균제 투여 중 간경변증에 의한 식도출혈 1예, 수술후 위장관 출혈 1예, 뇌 색전중 1예가 사망하였고, 1예는 Teicoplanin에 의한 심한 피부발진으로, 다른 1예는 봉와직염의 임상진단이 조직검사결과 악성종양의 근육침범으로 밝혀져 투약을 중단하였다.

• Biomedical Science Letters
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• v.6 no.3
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• pp.201-208
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• 2000

The vancomycin, one of the family of glycopeptide antibiotics, inhibits the synthesis of bacterial cell wall peptidoglycan and has been widely used against gram-positive bacterial infections, especially for a treatment of methicillin resistant S. aureus infection. However, clinical isolate which was intermediately resistant to vancomycin (Mu50: MIC 8 $\mu\textrm{g}$/ml) was isolated in recent years. In this study we performed vancomycin susceptibility test with the increment method and population analysis with clinical isolates S. aureus. Also we did several kinds of tests with three selected isolates (s129: MIC 7 $\mu\textrm{g}$/ml, s134: MIC 7 $\mu\textrm{g}$/ml, s135: MIC 8 $\mu\textrm{g}$/ml) to find out possible mechanism of vancomycin resistance. As a result, the prevalence of vancomycin resistant S. aureus isolates among S. aureus strains resistant to methicillin was 23.3% (25/107). The vancomycin resistances of isolated strains of S. aureus were between those of Mu5O and Mu3 strains. By PCR analysis, none of the isolates with decreased vancomycin susceptibility contained known vancomycin resistant genes such as vanA, vanB, vanC1, vanC2, and vanH. Major bands of 81 kDa, 58 kDa, 33 kDa, 28 kDa were demonstrable in whole cell lysates by SDS-PAGE from all three isolates as well as reference strains. And especially,45 kDa protein was overproduced in Mu50 strains. Among them increased production of NAD$^{+}$-linked-$_{D}$-lactate dehydrogenase (dnLDH) were detected from one clinical strain (s135) and Mu5O strain. From these data, we suggest that the mechanism of vancomycin resistance in these isolates are distinct from that in enterococci.

• Journal of Korean Foot and Ankle Society
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• v.22 no.1
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• pp.38-43
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• 2018

Purpose: Treatment of diabetic foot infection due to methicillin-resistant Staphylococcus aureus (MRSA) remains challenging. Applying vancomycin-impregnated cement is one of the best methods of treatment. Vancomycin-impregnated cement has been used worldwide; however, to date, there is a limited number of studies regarding its use. We evaluated the duration of antimicrobial activity of vancomycin-impregnated cement stored at room temperature after manufacturing. Materials and Methods: The vancomycin-impregnated cement was manufactured by mixing 1 g of vancomycin with 40 g of polymer and adding 17.90 g of liquid monomer. The cement dough was shaped into flat cylinders with diameter and height of 6 mm and 2 mm, respectively. Another cement of the same shape without mixing vancomycin was prepared as the negative control. All manufactured cements were sterilized with ethylene oxide gas and stored at room temperature. Each cement was placed on Mueller Hinton agar plate lawned with standard MRSA strain. Standard vancomycin disk and gentamicin disk were placed together. After 24 hours, the diameter of inhibition zone was measured, and if the diameter was less than 15 mm, vancomycin-impregnated cement was regarded as a loss of antimicrobial activity. The study was repeated every 2 weeks until vancomycin-impregnated cements lost their antimicrobial activity. Results: Vancomycin-impregnated cement stored for a duration of 16 weeks created a 14 mm inhibition zone, while vancomycin disk created a 15 mm inhibition zone. Vancomycin-impregnated cement stored for a duration of 17 weeks created 7 mm and 9 mm inhibition zones, while vancomycin disk created 16 mm and 15 mm inhibition zones, respectively. Conclusion: We found a decrease of antimicrobial activity in vancomycin-impregnated cements after 16 weeks. After 17 weeks, they showed definite loss of antimicrobial activity. Therefore, we recommend not using vancomycin-impregnated cement spacers that has been stored for more than 16 weeks at room temperature.