Blood Concentration Monitoring Of Vancomycin And Voriconazole And Evaluation Of Efficacy And Safety

Objective In order to understand the actual clinical use of vancomycin and voriconazole in a Third Class A Hospital,evaluate the efficacy and safety of vancomycin and voriconazole by clinical pharmacists participating in medication therapy management(MTM)through therapeutic drug monitoring(TDM),and provide reference for rational clinical use of vancomycin and voriconazole.Method Using the hospital information system(HIS)and combining with the daily work of TDM,we analyzed the medical records of patients who were treated with vancomycin or(and)voriconazole and undergone therapeutic drug monitoring in a Third Class A Hospital from January 2017 to December 2018.The clinical manifestations,liver and kidney functions,blood routine,ADR,CRP,PCT and microbial culture were recorded in detail.Finally,statistical analysis was carried out by SPSS software.Definition: P<0.05 was considered significant difference,and P≥0.05 was considered no significant difference.Results 1.127 patients underwent TDM while using vancomycin(Inspection rate was 30.09%),among which,53 cases(41.73%)were in the normal concentration group(10~20mg /L)and 29cases(22.83%)in the high concentration group(>20mg/L),with the total effective rate of 77.17%.There was no significant difference in efficacy between low concentration group(<10mg/L),normal concentration group(10~20mg /L)and high concentration group(>20mg/L)(P>0.05),and there was significant difference in ADR incidence between low concentration group and normal concentration group and high concentration group(P<0.05).2.52 patients underwent TDM while using voriconazole(inspection rate of 21.14%),among them,30 cases(57.69%)in normal concentration group(1~5.5mg/L),the total effective rate was 71.15%;Low concentration group(<1 mg/L)and normal concentration group(1~5.5 mg/L),the high concentration group(>5.5 mg/L)significant differences compared curative effect(P<0.05).There was a significant difference in the incidence of ADR between the concentration group and the high concentration group(P<0.05).Conclusion 1.There is no significant correlation between the serum concentration of vancomycin and clinical efficacy,but it is closely related to the incidence of adverse reactions.Controlling the serum concentration of vancomycin within the target range of 10~20mg/L can significantly reduce the risk of ADR.Blood drug concentration of voriconazole is closely related to clinical efficacy and adverse reactions.Controlling blood drug concentration within the target range of 1~5.5mg/L can improve clinical efficacy and reduce ADR.2.The low inspection rate of vancomycin and voriconazole TDM in this hospital indicates that clinical attention is not enough,and it also indicates the deficiency of clinical pharmacists in participating in MTM.