Increased Vancomycin Clearance in Patients with Solid Malignancies

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  • Izumisawa Tomohiro
    Laboratory of Physiological Chemistry, Institute of Medicinal Chemistry, Hoshi University Department of Laboratory Medicine, The Jikei University Kashiwa Hospital
  • Wakui Nobuyuki
    Division of Applied Pharmaceutical Education and Research, Hoshi University
  • Kaneko Tomoyoshi
    Department of Laboratory Medicine, The Jikei University Kashiwa Hospital
  • Soma Masakazu
    Department of Laboratory Medicine, The Jikei University Kashiwa Hospital
  • Imai Masahiko
    Laboratory of Physiological Chemistry, Institute of Medicinal Chemistry, Hoshi University
  • Saito Daisuke
    Laboratory of Physiological Chemistry, Institute of Medicinal Chemistry, Hoshi University
  • Hasegawa Hideo
    Department of Laboratory Medicine, The Jikei University Kashiwa Hospital
  • Horino Tetsuya
    Department of Infectious Diseases and Infection Control, Jikei University School of Medicine
  • Takahashi Noriko
    Laboratory of Physiological Chemistry, Institute of Medicinal Chemistry, Hoshi University

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Abstract

<p>Vancomycin (VAN) is an anti-microbial agent used to treat a number of bacterial infections, which has a high incidence of nephrotoxicity. We examined the pharmacokinetics of VAN retrospectively based on trough concentrations at large scale and identified pharmacokinetic differences between Japanese patients having solid malignancy and non-malignancy patients. Data were analyzed from 162 solid malignancy patients and 261 non-malignancy patients, including the patient’s background, VAN dose, and pharmacokinetics of VAN. We failed to detect differences in values for VAN clearance or shorter elimination half-lives between these two groups. In contrast, multiple regression analysis under adjusting for confounding factors by propensity score, showed that VAN clearance significantly increased in relation to solid malignancies in each stage. We conclude that VAN clearance in solid malignancy patients is increased and that the blood concentration of VAN becomes lower than expected. These results suggest that early monitoring of VAN levels in solid malignancy patients might be essential for maintaining desired effects without side-effects.</p>

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