Analysis Of Clinical Applications And Related Safety Factors Of Elderly Patients With Vancomycin

Objective：Through monitoring the drug safety and related high risk points ofvancomycin used in elderly patients, the risk factors for renal function damage causedby vancomycin were analyzed and the drug evaluation sample data of elderly patientstaking vancomycin were collected, so that to provide data support for establishing thecore assessment indicators of rational drug use of vancomycin，provide references forvarieties screening of high-risk drugs used in elderly patients, and reduce the risk ofclinical medication.Methods：By the method of multi-center study, the medication and safety informationof hospitalized elderly patients treated with vancomycin was analyzed in multi-stages,which included general situation, underlying diseases, therapeutic schedule and adversereaction, etc. In the first stage, the patients data from3hospitals (40cases of eachhospital) were collected for pre-experiment and improving data quality control programby the method of retrospective study. In the second stage, the patients data from13hospitals (30cases of each hospital) were collected for analying the rationality of druguse by the method of real world study.In addition, the valley value distribution of blooddrug concentration and the correlation between blood drug concentration and age, renalfunction and curative effect of the patients were analyzed.Results: The medications situation of472cases of senile in-patients from13hospitalsshowed that the incidence of adverse drug reactions was8.05%(38/472)，the drugutilization index (DUI) of vancomycin was0.77, the drug choice conformed to theindications standards. The proportion of taking drug for against pathogenic bacteria was49.58%(234/472), the dosage regimen of the patients with normal renal function was1g, q12h, accounted for40.71%, the dosage regimen of the patients with abnormal renalfunction was0.5g, q12h, accounted for34.85%. There was no statistically significantdifference in the values of serum creatinine and urea nitrogen between before and aftertreatment. There were166cases,362times therapeutic durg monitoring of472elderlypatiens been carried out, of which342cases were the valley value of blood drugconcentration,20cases were the peak value. The largest proportion (30.12%) was thevalley values which was less than10mg.l-1. Conclusion:1.The proportion of empirical therapy in clinic was more than a half, which wassignificantly higher. The concentration of the drug was slightly high as well.The abovesuggested that the awareness of choosing medicine according to the indications andmatching menstruum according to the instruction should be strengthened.2. Although individual dosage was generally low, the further analysis showed that thedrug dosage of the patients in renal insufficiency group were significantly lower thanthe normal renal function group.There was no significant change in indicators of renalfunction such as blood urea nitrogen, serum creatinine and so on, between before andafter vancomycin treatment, which implied that the clinician had taken more attention tothe internal connection between the drug use and renal function of the patients. Theliteratures about the adverse drug reactions of renal impairment caused by vancomycincould remind the clinicians to attach importance to renal function of the patients andadjust the treatment individually during the vancomycin treatment.3. The results of therapeutic durg monitoring showed that there was no significantdifference in monitoring proportion between the patients with renal insufficiency andnormal renal function. However, the monitoring values after monitoring for many timeswere within normal range more. Therefore, it is necessary to implement personalizedmedication more accurately, maintain the effective drug concentration, reduce thedrug-induced risks and drug-resistance through therapeutic durg monitoring. For thepatients with complicated infections, the clinicians should formulate individual targetconcentration and could exceed the upper limit of effective concentration whilestrengthening monitoring according to the patient’s condition and therapeutic goals. Atthe same time, it should be emphasized that the blood specimen collection and storagemust be more normative.