Necessity of Personalized Initial Loading Dose Calculation of Teicoplanin by Clinical Pharmacist -Examination of the Utility of Using Systemic Inflammatory Response Syndrome Score-

摘要

When teicoplanin (TEIC) is injected at the maintenance dose, a long period is required for achievement of the target plasma trough concentration because of its long elimination half-life. An initial loading dose is necessary for rapid achievement of an effective plasma trough concentration. Thus, we proposed that it is necessary for a pharmacist determine the initial loading dose of TEIC to reach an effective plasma trough concentration rapidly after its administration to a patient. In the present study, we evaluated the effectiveness of initial loading dose determination by pharmacists and physicians by comparing the achievement rate of target plasma trough concentrations (>15 mu g/mL) and expression of adverse effects. Among 61 patients, 34 were treated according to an initial loading dose determined by a pharmacist (pharmacist intervention) and 27 were treated according to the treating physician's discretion (non-pharmacist intervention). The achievement rate of target concentrations was 91.2% (plasma trough concentration 23.3 +/- 5.3 mu g/mL) in the pharmacist intervention group and 25.9% (plasma trough concentration 14.0 +/- 5.9 mu g/mL) in the non-pharmacist intervention group. There was no difference in the incidence of adverse effects between the two groups. Also, we found that systemic inflammatory response syndrome (SIRS) may have a correlation with plasma trough concentrations of TEIC. We suggest that the SIRS score could become a means way of determining initial loading dose. These findings suggest that it is potentially effective for a pharmacist to determine this initial dose in order to rapidly achieve the target plasma trough concentration of TEIC.