プロトコルに基づいた薬物治療管理の臨床アウトカム評価

• 片田 佳希

  京都大学医学部附属病院薬剤部

• 中川 俊作

  京都大学医学部附属病院薬剤部

• 田上 裕美

  京都大学医学部附属病院薬剤部

• 津田 真弘

  京都大学医学部附属病院薬剤部

• 都築 徹教

  京都大学医学部附属病院薬剤部

• 端 幸代

  京都大学医学部附属病院薬剤部

• 小高 瑞穂

  京都大学医学部附属病院薬剤部

• 米澤 淳

  京都大学医学部附属病院薬剤部

• 萱野 勇一郎

  京都大学医学部附属病院薬剤部

• 矢野 育子

  京都大学医学部附属病院薬剤部

• 南方 謙二

  京都大学医学部附属病院心臓血管外科

• 坂田 隆造

  京都大学医学部附属病院心臓血管外科

• 松原 和夫

  京都大学医学部附属病院薬剤部

書誌事項

タイトル別名

• Clinical Outcomes of Vancomycin Therapy by the Protocol-Based Pharmacotherapy Management (PBPM) including TDM-Order
• ～TDMオーダを含めたバンコマイシン処方設計支援～

抄録

Vancomycin (VCM) is a first-line antibiotic used for methicillin-resistant Staphylococcus aureus (MRSA), and therapeutic drug monitoring (TDM) is recommended to minimize the risk of nephrotoxicity and ensure successful therapeutic outcomes. In Kyoto University Hospital, we have developed a new approach of pharmacist intervention in the medication with VCM, which is named “Protocol-Based Pharmacotherapy Management (PBPM).” PBPM is based on a protocol approved in a hospital committee, which mentioned that pharmacists could order TDM and propose the most appropriate treatment plans with VCM to surgeons. From April 2011 to September 2014 in Kyoto University Hospital, a total of 54 patients hospitalized for cardiovascular surgeries received VCM without the treatment of hemodialysis. Twenty-nine patients before introducing PBPM were the control group. The VCM treatment according to PBPM was applied to 25 patients (protocol group). The incidence of acute kidney injury (AKI) due to VCM therapy, the retention rates of VCM blood concentration maintained in the therapeutic range (10-20 µg/mL) and in the toxic range (over 20 µg/mL) were retrospectively surveyed. The incidence of AKI was significantly lower in the protocol group than that in the control group (8.0% vs 31.0%, P < 0.05). The retention rates maintained in the therapeutic blood concentration range and in the toxic blood concentration range were significantly different between the control group and the protocol group. These results demonstrate that pharmaceutical intervention based on PBPM for MRSA treatment is effective for maintaining VCM blood concentration in the therapeutic range, resulting in a reduction of adverse drug reactions.

収録刊行物

• 医療薬学

  医療薬学 42 (1), 14-22, 2016

  一般社団法人日本医療薬学会

キーワード

• vancomycin
• pharmacist intervention
• TDM order
• acute kidney injury
• protocol based pharmacotherapy management (PBPM)

詳細情報

• CRID: 1390282679752378752
• NII論文ID: 130005286674
• DOI: 10.5649/jjphcs.42.14
• ISSN: 18821499
• ISSN: 1346342X
• Web Site: https://www.jstage.jst.go.jp/article/jjphcs/42/1/42_14/_pdf
• Web Site: https://search.jamas.or.jp/link/ui/2016109404
• 本文言語コード: ja
• データソース種別:
  • JaLC
  • Crossref
  • CiNii Articles
  • KAKEN
• 抄録ライセンスフラグ: 使用不可