Achievement of Vancomycin Therapeutic Goals in Critically Ill Patients: Early Individualization May Be Beneficial

Shahrami, Bita; Najmeddin, Farhad; Mousavi, Sarah; Ahmadi, Arezoo; Rouini, Mohammad Reza; Sadeghi, Kourosh; Mojtahedzadeh, Mojtaba

doi:10.1155/2016/1245815

Cited by 20 publications

(30 citation statements)

References 30 publications

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“…This is likely only to be achieved with individualised vancomycin dosing algorithms, based on specific patient characteristics (i.e. creatinine clearance, weight, age) . In the intensive care setting, individualised dosing using Bayesian forecasting has been shown to improve attainment of target vancomycin concentrations when compared to standard empiric dosing in adults .…”

Section: Discussionmentioning

confidence: 99%

“…creatinine clearance, weight, age). 47,48 In the intensive care setting, individualised dosing using Bayesian forecasting has been shown to improve attainment of target vancomycin concentrations when compared to standard empiric dosing in adults. 49,50 In neonates in intensive care, better attainment of target vancomycin concentrations has been shown with individualisation of dosing using a pharmacokinetic model, compared with dosing following standard guidelines (63 vs 39%, P < .02).…”

Section: Discussionmentioning

confidence: 99%

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Vancomycin is commonly under‐dosed in critically ill children and neonates

Sosnin

Curtis

Cranswick

et al. 2019

Brit J Clinical Pharma

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Aims Vancomycin is frequently used in critically ill children in whom the drug pharmacokinetics are significantly altered as a result of changes in renal clearance and volume of distribution. Therapeutic drug monitoring (TDM) is recommended to achieve vancomycin trough concentrations between 10 and 20 mg/L. In this study we reviewed vancomycin dosing, TDM and treatment outcomes in paediatric and neonatal intensive care unit patients. Methods We reviewed the medical records of all patients receiving intravenous vancomycin in a tertiary paediatric and neonatal intensive care unit over a 10‐month period. Demographic, vancomycin dosing, TDM and drug‐related adverse effects data were collected. Results In total, 115 children received 126 courses of vancomycin and had at least 1 TDM blood sample taken at steady state. In only 38/126 (30%) courses was the target concentration (10–20 mg/L) achieved at the initial steady state trough sample. Of the 88 courses that had initial trough concentrations outside the target range, the dose was adjusted in only 49 (56%). Overall, minimum doses of 30 mg/kg/day in neonates with a corrected gestational age of <35 weeks, and 50 mg/kg/day in older children, were required to achieve target vancomycin concentrations. Vancomycin‐attributable nephrotoxicity occurred in 10/126 (8%) courses and there were no episodes of red man syndrome. Conclusion In critically ill children, individualised dosing is needed. In the absence of Bayesian model‐based dosing, in children with normal renal function, empiric vancomycin doses of at least 30 mg/kg/day in neonates of <35 weeks corrected gestational age, and 50 mg/kg/day in older children, should be considered. Optimisation of TDM practices through the development of protocols, ideally built into electronic medical records, should be considered.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Vancomycin is commonly under‐dosed in critically ill children and neonates

Sosnin

Curtis

Cranswick

et al. 2019

Brit J Clinical Pharma

View full text Add to dashboard Cite

show abstract

“…Due to the logistic challenges of such determination in clinical practice, it was demonstrated that such value could be obtained with trough serum levels of vancomycin between 10 and 20 mg/L . Larger concentrations were studied, but without evidence of better therapeutic outcomes …”

Section: Vancomycinmentioning

confidence: 99%

“…A clinical study conducted by Shahrami et al showed that, after 20 critically ill patients received an attack dose of 25 mg/kg vancomycin, the strategy that best guarantees AUC/MIC ≥400 and serum level ≥15 mg/L are individual doses based on serum vancomycin concentration.…”

Section: Vancomycinmentioning

confidence: 99%

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Vancomycin dosing, monitoring and toxicity: Critical review of the clinical practice

Zamoner

Prado

Balbi

et al. 2019

Clin Exp Pharma Physio

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Summary Vancomycin is an antibiotic used in the treatment of infections caused by multidrug‐resistant Gram‐positive bacteria, especially methicillin‐resistant Staphylococcus aureus. In the last decades, vancomycin has been widely used in hospital environments due to the increasing incidence of sepsis and septic shock. Sepsis may lead to multiple organ failure; it is considered a risk factor for the development of acute kidney injury (AKI), with an overall mortality rate of around 45%, which can reach the surprising rate of 70% with the combination of AKI and sepsis. Considering the high mortality rate of sepsis and its related costs of hospitalization and treatment, specific measures should be adopted, such as early‐goal treatment protocols: proper and early administration of antimicrobials, fluids, vasoactive drugs and transfusion support. Besides the careful selection of the antimicrobial, another concern related to critically ill patients is the proper dose of the antimicrobial, since pharmacokinetic changes are observed due to drug absorption, distribution, metabolism and elimination. Gram‐positive pathogens are very common in hospitalized patients with septic shock, so vancomycin has been the antimicrobial of choice for more than 60 years. However, discussions about its dosage, administration and monitoring are extremely important, considering the risk of nephrotoxicity and the emergence of resistant S. aureus. This narrative review aims to discuss controversial aspects related to the efficacy and safety of vancomycin, correlating them with data available in the literature and identifying knowledge gaps in guide future lines of research.

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Characterizing Day 1 Area Under the Curve Following Vancomycin Loading Dose Administration in Adult Hospitalized Patients Using Non-Trapezoidal Linear Pharmacokinetic Equations: A Retrospective Observational Study

Shremo Msdi,

Abdul-Mutakabbir,

Tan

2024

Infect Dis Ther

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Introduction Methicillin-resistant Staphylococcus aureus (MRSA) infections are a serious threat to public health. Vancomycin (VAN) remains the primary treatment for these infections, and achieving the recommended area under the curve (AUC) target has been linked to improved clinical outcomes. The current VAN therapeutic monitoring guidelines recommend a loading dose (LD) of 20–35 mg/kg to rapidly attain targeted VAN exposures within 24 h of therapy. However, there is a paucity of data describing the impact of VAN LD on day 1 area under the curve (AUC 0–24 ). This study aims to employ pharmacokinetic (PK) equations to calculate and describe the AUC 0–24 following a VAN LD of 20 mg/kg. Methods This was a retrospective study of adult patients who were loaded with VAN 20 mg/kg, received ≥ 48 h of treatment, and had two consecutive serum VAN levels collected within 24 h. Linear, non-trapezoidal PK equations and two post-infusion VAN levels were used to calculate AUC 0–24 . Therapeutic AUC 0–24 was defined as 400–600 mg/l*h. Results Among 123 included patients, the median age was 46 years (IQR 36, 62), 54% (67/123) of the patients had a body mass index (BMI) ≥ 30 kg/m 2 and 27% (33/123) were admitted to the intensive care unit (ICU). Following a LD of 20 mg/kg, 50% (61/123) of the patients met the therapeutic AUC 0–24 , while 22% (27/123) of the patients were subtherapeutic, and 28% (35/123) were supratherapeutic. Compared with patients who achieved therapeutic AUC 0–24 , patients with subtherapeutic AUC 0–24 were more likely to be younger (44 vs. 37 years old) and have a BMI ≥ 30 kg/m 2 (67 vs. 52%). In contrast, patients with supratherapeutic AUC 0–24 were more likely to be older (64 vs. 44 years old) and to have chronic kidney disease diagnosis (23 vs. 7%) when compared to patients who achieved a therapeutic AUC 0–24. Conclusions Only 50% of patients achieve the target AUC 0-24 following a VAN 20 mg/kg LD, with younger, heavier patients underexposed and older patients with renal impairment overexposed, suggesting that different dosing strategies are needed for these populations. Supplementary Information The online version contains supplementary material available at 10.1007/s40121-024-01004-2.

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Achievement of Vancomycin Therapeutic Goals in Critically Ill Patients: Early Individualization May Be Beneficial

Cited by 20 publications

References 30 publications

Vancomycin is commonly under‐dosed in critically ill children and neonates

Vancomycin is commonly under‐dosed in critically ill children and neonates

Vancomycin dosing, monitoring and toxicity: Critical review of the clinical practice

Characterizing Day 1 Area Under the Curve Following Vancomycin Loading Dose Administration in Adult Hospitalized Patients Using Non-Trapezoidal Linear Pharmacokinetic Equations: A Retrospective Observational Study

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