Author/Editor		Mavsar-Najdenov, Brigita; Koder, Barbara; Grabnar, Iztok; Mrhar, Aleš
Title		Analiza učinkovitosti in varnosti zdravljenja z vankomicinom
Translated title		Vancomycin treatment: analysis of efficacy and safety
Type		članek
Source		Zdrav Vestn
Vol. and No.		Letnik 76, št. 11
Publication year		2007
Volume		str. 695-700
Language		slo
Abstract		Background According to vancomycin properties and to assure rational use of antimicrobials vancomycin is ranged among reserved antimicrobials with restricted regimen of prescribing. Its useful spectrum is restricted to Gram-positive pathogens with particular activity against multiple resistant coagulase negative staphylococci and methicillin-resistant Staphylococcus aureus causing severe infectious diseases as septicemias, endocarditis, hospital pneumonia, skin and soft tissue infections, infections associated with venous catheters and diphteroidal infections in immunocompromised patients. In most cases vancomycin is prescribed to critically ill patients often with co-morbidity of renal disfunction or renal failure. In such cases excessive vancomycin retention in the body must be considered. In patients with vancomycin plasma levels exceeding 10 µmol/L (15 µg/mL) the risk of nephrotoxicity is increased. Optimal antibiotic therapy, tailored to the individual patient is the only way to maintain therapeutic vancomycin plasma levels. This approach is also of great importance to combat antimicrobial resistance. Materials and methods The aim of the study was to determine proper use of vancomycin in real hospital environment. In this retrospective analysis 26 patients treated with vancomycin in the Jesenice General Hospital in the years 2005 and 2006 were included. All clinical data were obtained from patient records. Vancomycin plasma levels were obtained from Hospital Department of Laboratory Diagnostics. Pharmacokinetic analysis of clinical and laboratory data was performed at the Department of Biopharmaceutics and Pharmacokinetics of Faculty of Pharmacy at University of Ljubljana applying population approach by nonlinear mixed effects modeling as implemented in the NONMEM® computer programme. (Abstract truncated at 2000 characters)
Summary		Izhodišča Vankomicin uvrščamo v skupino rezervnih antibiotikov na podlagi njegovih lastnosti in za doseganje racionalnega protimikrobnega zdravljenja. Običajno ga uporabimo kot zadnjo možnost za zdravljenje okužb, ki jih povzročajo na peniciline odporni stafilokoki, streptokoki in enterokoki, ali če je bolnik alergičen na penicilinske protimikrobne učinkovine ter za zdravljenje okužb z difteroidi pri imunsko oslabljenih bolnikih. Vankomicin najpogosteje predpišemo kritično bolnim v enotah za intenzivno zdravljenje. Bolniki imajo pogosto okvarjeno delovanje ledvic, zato obstaja možnost čezmernega zadrževanja učinkovine v organizmu. Pri plazemskih koncentracijah vankomicina, ki presegajo 10 µmol/L (15 µg/mL), se poveča tveganje za pojav nefrotoksičnosti pri že sicer prizadetih bolnikih. Zato je nujno stalno spremljanje in nadzorovanje ustrezne plazemske koncentracije vankomicina, kar pa je pri kritično bolnih možno le z individualizacijo zdravljenja. Uporaba vankomicina mora biti skrbno načrtovana ne le zaradi neželenih učinkov, pač pa tudi zaradi nevarnosti pojava odpornosti mikroorganizmov. Materiali in metode Naš namen je bil ugotoviti ustreznost zdravljenja z vankomicinom v realnem bolnišničnem okolju. V retrospektivni študiji smo preučevali skupino 26 bolnikov, ki so se zdravili z vankomicinom v Splošni bolnišnici Jesenice v letih 2005 in 2006. Iz popisov bolnikov smo pridobili klinične podatke, ki so se nanašali na zdravljenje z vankomicinom. Vrednosti plazemskih koncentracij vankomicina nam je posredoval bolnišnični Odsek za laboratorijsko diagnostiko. Farmakokinetično analizo podatkov, pridobljenih iz popisov bolnikov, smo izvedli na Fakulteti za farmacijo Univerze v Ljubljani. Uporabili smo populacijski pristop analize na osnovi nelinearnega modeliranja mešanih učinkov z računalniškim programom NONMEM®. (Izvleček prekinjen pri 2000 znakih)
Descriptors		BACTERIAL INFECTIONS VANCOMYCIN