Developing a scale for monitoring the serum concentration of aminoglycoside

• Main Authors: Ciou-Rong Chen, 陳秋榮
• Other Authors: Chun-Wei Tung
• Format: Others
• Language: zh-TW
• Published: 2016
• Online Access: http://ndltd.ncl.edu.tw/handle/06879692616111712443

碩士 === 高雄醫學大學 === 藥學系碩士在職專班 === 104 === Therapeutic Drug Monitoring (TDM) is to monitor drug levels in blood for improving drug efficacy and reducing side effects for drugs with a small therapeutic index. Due to the high complexity of traditional TDM models, it is difficult to be applied to clinical practice. The development of a simple scale could benefit the clinical applications. The purposes of this study were to evaluate the factor and relevance of the serum concentrations of gentamicin by regression analysis. In this retrospective study, we collected the data from Therapeutic Drug Monitoring database of patients who used gentamicin during the hospital stay of a teaching hospital located in the south of Taiwan. A total of 2,511 patients were eligible for inclusion, this study applied linear regression and logistic regression analysis to evaluate the important variables and their correlations to the estimated concentrations of gentamicin in blood from a TDM model. For linear regression analysis of peak-related factors, significant factors include patient''s age, gender, body weight, initial dose, dosing interval Q8H, Q12H and Q24H (p<0.01); using a multivariate analysis, we found that 1kg increase in body weight relates to 0.11μg/ml reduce in peak level; 1mg increase in initial dose relates to 0.06μg/ml increase in peak level, these two factors account 88% variation. For logistic regression analysis of peak-related factors, significant factors include age, gender, body weight, initial dose, dosing interval Q8H, Q12H and Q24H (p<0.01); using a multivariate analysis, significant factors include age, body weight, initial dose and dosing interval Q8H (p<0.01). For linear regression analysis of trough-related factors, significant factors include age, body weight, initial dose, dosing interval Q8H, Q12H and Q24H (p<0.01). using a multivariate analysis, we found that 1mg/dl increase in serum creatinine relates to 0.96μg/ml increase in trough level, 1year increase in age relates to 0.01μg/ml increase in trough level, 1kg increase in body weight relates to 0.02μg/ml reduce in trough level, dosing interval Q24H reduce trough level of 0.61μg/ml, these factors account 57% variation. For logistic regression analysis of Trough-related factors, significant factors include age, body weight, serum creatinine, initial dose, dosing interval Q8H, Q12H and Q24H (p<0.01); after multivariate adjustment, significant factors include age, body weight, serum creatinine, initial dose, dosing interval Q8H, Q12H and Q24H (p<0.01). This study applied linear regression analysis to evaluate the important variables and their correlations to the estimated concentrations of gentamicin in blood from a TDM model. The variables were then utilized to develop a simple scale to replace the traditional TDM model. The methodology can be further used to develop scales for various drugs.