PurposeThe objective of this study was to evaluate a standard starting dose of vancomycin and a possible relationship between body mass index (BMI) and plasma levels (therapeutic range 10–15 µg/mL).Material and methodsRetrospective study of samples collected in a tertiary hospital of 413 beds, over a period of 3 years (2012–2014), in patients who were prescribed a standard initial dose of vancomycin 1 g/12 h.Data collected were: weight, height, gender, age, creatinine plasma levels and vancomycin plasma levels. The collected data were grouped according to BMI (18.5–25=normal weight, 25–30=overweight and >30=obesity) and plasma concentrations of vancomycin. Exclusion criteria were: samples from patients with renal insufficiency (creatinine >1.2 mg/dL) and patients with an initial dose of vancomycin different from the standard dose.The relationship between plasma levels of vancomycin and BMI was assessed by ANOVA statistical analysis.Results114 determinations of plasma levels of vancomycin from different patients were reviewed; 51 normal weight patients, 45 overweight patients and 18 obese patients, with a mean age of 61.27 ± 18.49, 68.46 ± 13.07 and 66.27 ± 13.47 years, respectively.In the normal weight group, 74.5% were men and 25.5% were women; in overweight group, 73.3% were men and 26.7% were women; and in obesity group, 66.6% were men and 33.3% were women.Mean (SD) plasma levels of vancomycin in the normal weight group were 13.98 ± 10.61 µg/mL, in the overweight group 13.77 ± 8.32 µg/mL and in the obese group 10.7 ± 4.67 µg/mL.In the statistical study, we obtained a value distribution F of 1.1669, less than 3.09, a value that should be overcome to have statistical significance (95%).ConclusionThe standard starting dose of 1 g/12 h reaches the therapeutic range in most patients. There was no statistically significant relationship between BMI and mean plasma levels of vancomycin in our study, possibly because of the small sample size.No conflict of interest.
BackgroundPatients with multiple antiretroviral therapy (MAT), defined as a combination of at least 3 drugs with different mechanisms of action, are on a difficult and costly treatment which may also affect treatment adherence.PurposeTo describe characteristics of HIV patients with multiple antiretroviral therapy and to evaluate the efficacy and adherence to the treatment.Material and methodsRetrospective observational study from June to December 2013. The inclusion criteria for our study were: MAT patients without changes in their treatment in the last 24 weeks. Data collected: demographics, current MAT, duration of treatment for HIV, adherence, resistance profile, viral load (VL) and CD4 count. Patients were classified as adherent (>90%) and non-adherent (<90%) by two independent methods: pharmacy dispensing records and SMAQ (simplified medicines adherence questionnaire) interview. Efficacy was evaluated by CD4 cells count and VL < 50 copies/mL, however we also considered CV < 200 copies/mL as a good indicator of treatment response.ResultsA total of 49 patients were eligible in this study, 76% male, mean age 46.5 ± 9.9 years. The mean no. of MAT drugs was 4 (range 3–6) and the mean duration of treatment for HIV was 12 (range 1–17) years. Regarding resistance studies: 9 patients were resistant to some antiretroviral, it was not possible to perform resistance studies in 10 patients (20.4%) due to the low VL (<1,000 copies/mL), it was not requested in 28 patients (57.1%) and 2 patients did not show resistance. Seven, eight and two patients showed resistance to analogues, non-analogues and protease inhibitors, respectively. The mean adherence was 94% and 40 patients (81.6%) had a percentage adherence superior to 90%. As to the efficacy variables: 32 (65.3%) and 46 (93.8%) patients had VL < 50 copies/mL and <200 copies/mL, respectively and 40 patients (81.6%) had a CD4 cell count >250 copies/mL.ConclusionMost patients had effective treatments. The complexity of the treatment did not have a negative impact on adherence. All patients with a resistance profile had their treatment optimised according to it.References and/or AcknowledgementsNo conflict of interest.
BackgroundDuring hospital admission, therapeutic interchange (TI) is performed on patients in treatment with angiotensin receptor blockers (ARBs) different from losartan, which are not included in the Pharmacotherapeutic Formulary. After TI, control of blood pressure(BP) should be stable.PurposeTo evaluate the effectiveness of the TI of ARBs during the hospital stay,comparing the number of hypertensive patients with controlled BP before and after TI.Material and methodsObservational prospective cohort study carried out from April to May 2016. Patients with hypertension treated with an ARBs not included in the Pharmacotherapeutic Formulary were enrolled, following them until discharge. Patients with a ARBs-conditional treatment according to blood pressure, people under 18 years’ old, pregnant females and patients with an hospital stay of 2 or less days were excluded. Patients were recommended a TI, being classified as exposed those in which the prescribing physician accepted the TI and as unexposed those in which the TI was rejected. The variables collected were:sex, age, main diagnosis, hospital stay, daily value of BP during hospital setting and BP before admission.ResultsA total of 54 patients were enrolled, including 39 exposed and 15 unexposed. The 65% were female, 26 (67%) in the exposed group and nine (60%) in the unexposed group. The mean age was 74.6 years’ old, 76.5 years and 69.5 years respectively. In 53%, the main diagnosis was cardiac or respiratory pathology. The mean stay was 5.9 days for the exposed group, in contrast to 8.5 days for the unexposed group. Sixty-nine per centof the exposed group had a stable BP during admission versus 53% of the unexposed group. Five patients from the exposed group who did not control BP at home were able to control it during admission. However, four patients who had adequate BP control at home did not achieve it during admission, either because of the main diagnosis or because TI was not effective. Regarding the unexposed patients, there were two patients with controlled BP at home that did not have BP control during hospital stay.ConclusionTherapeutic interchange has proved to be effective as it does not lead to a worsening of BP control over previous treatment. The majority of patients with TI controlled BP during hospital admission. Limitation: the average stay is lower in the cases, but it is not known if some external factors could have influenced this.No conflict of interest
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