Influence of Systemic Inflammatory Response Syndrome on the Pharmacokinetics of Vancomycin

Abstract

Therapeutic drug monitoring (TDM) of vancomycin (VCM) is recommended to minimize its nephrotoxicity and maximize e‹cacy. Recently, the concept of systemic in‰ammatory response syndrome (SIRS) has been introduced to describe a clinical state resulting from the actions of complex intrinsic mediators in an acute-phase systemic response. However, there are few reports on the pharmacokinetics of VCM in patients with SIRS. This study investigated the eŠect of SIRS on the pharmacokinetics of VCM by analyzing the predictability of TDM and pharmacokinetic parameters in 31 non-SIRS patients and 52 SIRS patients, with stratiˆcation by SIRS score. The mean prediction error (ME) and mean absolute prediction error in SIRS score 2 and 3 patients diŠered from those in non-SIRS patients. The ME in the score 4 group showed a negative value. In the comparison of pharmacokinetic parameters by SIRS score, a signiˆcantly lower CL vcm value was observed at score 4 compared with scores 2 and 3, a higher Vd value was observed at score 4 compared with non-SIRS and at score 3, and a longer T 1/2 was observed at score 2. In the comparison of patient characteristics by SIRS score, albumin, aspartate aminotransferase, and alanine aminotransferase levels showed diŠerences among the scores. However, no correlation was observed between VCM pharmacokinetics and these three laboratory parameters. Theseˆndings suggest that the pharmacokinetics of VCM may be aŠected by the pathology of SIRS rather than by patient characteristics.