Contribution of Non-renal Clearance to the Elimination of Vancomycin during Repeated Intravenous Administration in Elderly Patients

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著者

    • CHO Toshihiro
    • 昭和大学医学部薬理 Department of Pharmacology, School of Medicine, Showa University
    • UCHIDA Eiji
    • 昭和大学医学部薬理 Department of Pharmacology, School of Medicine, Showa University
    • OGUMA Takayoshi
    • 塩野義製薬(株)新薬研究所 Developmental Research Laboratories, Shionogi and Co., Ltd.
    • UCHIDA Naoki
    • 昭和大学医学部薬理 Department of Pharmacology, School of Medicine, Showa University
    • YASUDA Kuninobu
    • 昭和大学医学部薬理 Department of Pharmacology, School of Medicine, Showa University
    • SHIMADA Ken
    • 昭和大学医学部薬理 Department of Pharmacology, School of Medicine, Showa University
    • KOBAYASHI Shinichi
    • 聖マリアンナ医科大学薬理 Department of Pharmacology, St. Marianna University School of Medicine
    • YASUHARA Hajime
    • 昭和大学医学部薬理 Department of Pharmacology, School of Medicine, Showa University

抄録

In order to clarify vancomycin pharmacokinetics in a Japanese elderly population, vancomycin (10 mg/kg) was repeatedly administered to 6 elderly female patients with methicillin-resistant <I>Staphylococcus aureus</I> (MRSA) infections (age 78 .3±5.9 years, weight 34.8±9.4 kg, CL<SUB>CR</SUB> 41.9±19.8 ml/min, mean±SD) by 1-hour constant infusion for 6days. Vancomycin was given to elderly patients once on day l and 6, and twice on day 2 to day 5 at 12-hour.intervals. Six healthy male volunteers (age 22 .0±1.7 years, weight 62.7±7.5kg, CL<SUB>CR</SUB> 115.0±9.6 ml/min, mean±SD) were administered vancomvcin once by 1-hour infusion. Serum and urinary vancomycin concentrations were measured by fluorescence polarization immunoassay and bioassay, respectively . Total clearance (CL) of vancomycin was 95.50±15.74 ml/min in the healthy control group subjects, while the value of CL was 35.21±13.29 ml/min in the elderly patients on 1st day. In elderly patients, vancomycin was substantially eliminated extrarenally in comparison with the healthy subjects. Pharmacokinetic parameters were compared between day 1 and day 6 in the elderly patients. Nonlinear pharmacokinetics was observed during multiple administration, t<SUB>1/2</SUB> was prolonged from 12.99±7.11 to 21.95±12.00 hour on day 6 (p<0 .05). CL significantly decreased from 35.21±13.29 to 23.64±8 .50 ml/min on day 6 (p<0.05).In contrast, renal clearance of vancomycin (CL<SUB>R</SUB>) remained constant throughout the study (15.06±5.86 and 17.76±7.78 ml/min on day 1 and day 6, respectively). The ratio of non renal clearance (CL<SUB>NR</SUB>) to CL was decreased from 0.568 (mean) to 0.268 after multiple dosing of vancomycin. The results suggested that vancomycin was eliminated mainly extrarenally in the elderly patients and that this extrarenal elimination was reduced during the repeated administration. These findings may have clinical implications for the long-term treatment of elderly patients with MRSA infections .

収録刊行物

  • 臨床薬理 = JAPANESE JOURNAL OF CLINICAL PHARMACOLOGY AND THERAPEUTICS

    臨床薬理 = JAPANESE JOURNAL OF CLINICAL PHARMACOLOGY AND THERAPEUTICS 26(3), 743-751, 1995-09-30

    一般社団法人 日本臨床薬理学会

参考文献:  23件中 1-23件 を表示

被引用文献:  2件中 1-2件 を表示

各種コード

  • NII論文ID(NAID)
    10013831583
  • NII書誌ID(NCID)
    AN0025404X
  • 本文言語コード
    ENG
  • 資料種別
    ART
  • ISSN
    03881601
  • データ提供元
    CJP書誌  CJP引用  J-STAGE 
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