PHÂN TÍCH KẾT QUẢ HIỆU CHỈNH LIỀU VANCOMYCIN THÔNG QUA GIÁM SÁT NỒNG ĐỘ THUỐC TRONG MÁU BẰNG PHƯƠNG PHÁP ƯỚC ĐOÁN AUC THEO BAYES TRÊN BỆNH NHÂN NGƯỜI LỚN TẠI VIỆN HUYẾT HỌC - TRUYỀN MÁU TRUNG ƯƠNG

Abstract

Objective: Analyze the results of the adjusted vancomycin dosing with AUC-based therapeutic drug monitoring (TDM) via the Bayesian approach in adult patients at National institute of hematology and blood transfusion. Evaluate the impact of age, creatinine clearance and febrile neutropenia on vancomycin exposures. Method: A prospective study was conducted in hematological patients with underlying infectious diseases treated with vancomycin. Based on TDM concentrations, calculations were performed using SmartDoseAI software to identify the AUC value and suggest new dosing regimens achieving a target exposure of AUC 400 – 600 mg.h/L. Results: A total of 120 patients were included. The target AUC attainment was improved after the 1^st and 2^nd dosing adjustments, from 45.0% to 83.3% and 97.2%. Patients with febrile neutropenia (FN) had higher clearance of vancomycin (Clvan) (5.65 vs. 3.87 L/h, p < 0.001) and lower AUC compared to the figures of non-FN patients (412.83 vs. 475.76, p = 0.006). Additionally, both elderly patients (≥ 60 years) and those with high creatinine clearance (≥ 90 mL/min) significantly impacted on Clvan and the estimated AUC value. Conclusions: These findings emphasize the necessity of vancomycin TDM and the Bayesian approach in individualizing doses at the bedside.