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Evaluation of the Effect of Initial dose of Vancomycin using Serum Cystatin C as a Marker in Elderly Patients
Sung Joon Jin, M.D.1, Sung Chang Bae, M.D.1, Hye Won Kim, M.D.1, Hye Kyung Kim, R.Ph.2, Eun Joo Na, R.Ph.2, Bo Sook Ahn, R.Ph.2, Jun Yong Choi, M.D.1, Chang Oh Kim, M.D.1, June Myung Kim, M.D.1 and Young Goo Song, M.D.1,2
Department of Internal Medicine1, Yonsei University College of Medicine, Seoul, Therapeutic Drug Monitoring Team2, Gangnam Severance Hospital, Seoul, Korea
Vol.41 Num.4 (p224~229)
Background:It has been suggested that the glomerular filtration rate can be predicted on the basis of serum cystatin C concentration. The aim of this study was to investigate the clinical utility of serum cystatin C as a marker of renal function and to evaluate the effect of an initial dose of vancomycin using serum cystatin C concentration in elderly patients.
Materials and Methods:Data was collected from July 2006 to September 2008. The subjects were elderly patients (?60-years-of-age; n=number of patients) who had been treated with vancomycin. Serum concentrations of parameters including vancomycin, creatinine, and cystatin C were measured. Correlations between measured vancomycin concentrations and predicted vancomycin concentrations based on serum cystatin C or serum creatinine were compared, and the initial dose setting of vancomycin on the basis of serum cystatin C concentration was evaluated.
Results:Serum cystatin C was a good marker of renal function in comparison with serum creatinine for various doses of vancomycin in the elderly subject. In subpopulation (n=88) with normal serum cystatin C level (?1.2 mg/L) who were treated with routine adult vancomycin dose (1g q 12 hours), vancomycin concentration was within the therapeutic range (5-15 mg/L) in 68 patients (77.3%), and was <20 mg/L in 77 of the 88 patients (88.5 %).
Conclusions:Predictive prowess of serum vancomycin concentrations on the basis of the serum cystatin C concentration could be better than that based on the serum creatinine concentration in elderly patients.
Keywords : Vancomycin, Therapeutic drug monitoring, Cystatin C