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SU-CHENNIU, B.D., is Pharmacist; and SHIN-TARNG DENG, B.D., M.B.A., is Chief Pharmacist, Department of Pharmacy, Chang Gung Memorial Hospital (CGMH), Taipei, Taiwan. MING-HSUN LEE, M.D., PH.D., is Director, Clinical Microbiology Laboratory, and Attending Physician, Division of Infectious Diseases, Department of Internal Medicine, CGMH, Chang Gung University College of Medicine (CGUCM), Taoyuan, Taiwan. CHENG HO, M.D., is Attending Physician, Division of Metabolism and Endocrinology, Department of Internal Medicine, CGMH, and Lecturer of Medicine, CGUCM. HUNG-YU CHANG, M.D., is Attending Physician, Division of Metabolism and Endocrinology, Department of Internal Medicine, CGMH, and Lecturer of Medicine, CGUCM. FENG-HSUAN LIU, M.D., is Attending Physician, Division of Metabolism and Endocrinology, Department of Internal Medicine, CGMH, and Lecturer of Medicine, CGUCM.

Address correspondence to Dr. Liu at the Division of Metabolism and Endocrinology, Department of Internal Medicine, Chang Gung Memorial Hospital, 5 Fushing Street, Kweishan Hsiang, Taoyuan County, Taiwan 333, Republic of China (a122liu{at}adm.cgmh.org.tw).

Purpose. The clinical efficacy of a modified vancomycin dosing protocol with a conventional regimen for managing patients with diabetic foot infections caused by methicillin-resistant Staphylococcus aureus (MRSA) was evaluated. Methods. This prospective study was conducted from January 2002 to December 2004 at the diabetic ward of Chang Gung Memorial Hospital—Linkou in Taiwan. All diabetic patients with MRSA-related diabetic foot infections confirmed by wound cultures were enrolled in this study. Patients treated with the conventional protocol (from 2002 to 2003) received vancomycin 10–15 mg/kg (up to 1 g) over 60 minutes every 12 hours if their serum creatinine (SCr) concentration was 0.4–1.4 mg/dL according to the estimation of creatinine clearance (CLcr). Patients treated with the modified vancomycin dosing protocol (from 2003 to 2004) received vancomycin according to their SCr level, age, and concurrent gentamicin dosage. Data analyzed included patients’ age, sex, body weight, SCr level, CLcr, serum vancomycin peak and trough levels, vancomycin dosage, treatment period, and duration of hospital stay. Results. A total of 85 patients were enrolled in this study. The conventional protocol group achieved substantially higher serum vancomycin levels than those recommended by the British National Formulary (BNF). Although the vancomycin dosage in the modified protocol was lower than that in the conventional protocol, trough and peak vancomycin levels remained within the range recommended by the BNF. The duration of hospitalization and treatment did not significantly differ between the two groups. Conclusion. A modified vancomycin dosing protocol for treating diabetic foot infections caused by MRSA was superior to the conventional dosing regimen in achieving therapeutic serum levels of vancomycin. Index terms: Antibiotics; Blood levels; Diabetic foot; Dosage; Hospitals; Methicillin; Penicillins; Protocols; Resistance; Staphylococcal infections; Staphylococcus aureus; Vancomycin