Continuous intravenous administration of vancomycin in medical intensive care unit patients

Saugel, Bernd; Nowack, Marisa Claudia Michelle; Hapfelmeier, Alexander; Umgelter, Andreas; Schultheiß, Caroline; Thies, Philipp; Phillip, Veit; Eyer, Florian; Schmid, Roland M.; Huber, Wolfgang

doi:10.1016/j.jcrc.2012.02.003

Cited by 51 publications

(60 citation statements)

References 19 publications

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“…Vancomycin is a non‐concentration‐dependent antibiotic, meaning it does not require high peak concentrations for efficacy . Vancomycin trough levels have been routinely used as a surrogate therapeutic marker to monitor safety and efficacy, as well as to indicate the need for dose adjustments, although it is the AUC 24 to MIC ratio that best correlates to clinical outcomes . If the MIC is ≤1 mg/L, vancomycin therapy is warranted .…”

Section: Resultsmentioning

confidence: 99%

“…reported that of 146 patients, 19 required renal replacement therapy after vancomycin was initiated. Of the group that required renal replacement therapy, seven of 94 (7%) were treated with CI vancomycin and 12 of 52 (23%) were treated via II ( P = 0·007) …”

Section: Resultsmentioning

confidence: 99%

“…Saugel et al . reported giving loading doses of 1000 mg or 1250 mg, followed by a CI rate of 60 mg/h.…”

Section: Resultsmentioning

confidence: 99%

“…Numerous reports suggest that CI is widely used outside of the United States, with many studies in European hospitals indicating that CI is a commonly used method of vancomycin administration . One report from a university hospital in Germany indicated that the standard route of administration of vancomycin in the intensive care unit (ICU) is CI .…”

Section: What Is Known and Objectivementioning

confidence: 99%

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The pharmacokinetic/pharmacodynamic rationale for administering vancomycin via continuous infusion

2015

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SUMMARYWhat is known and objective: Vancomycin is administered via intermittent infusion (II) almost exclusively in the United States, whereas continuous infusion (CI) dosing methods are used regularly in many European countries. The purpose of this literature analysis is to review current evidence regarding the advantages and disadvantages of CI vancomycin in relation to II, based on the pharmacokinetic and pharmacodynamic aspects of dosing and monitoring therapy, and to identify current practices of CI vancomycin dosing. Methods: Medline, Cochrane and GoogleScholar databases were searched using vancomycin as a MeSH term, along with continuous and infusion in all fields, which identified 136 citations. A second search added the terms intermittent and survey, producing nine additional articles. All articles that reported an assessment of CI or II vancomycin administration in adult patients, based on clinical, pharmacokinetic, cost or monitoring considerations, were identified. A total of 43 publications were determined to be suitable for final analysis and possible inclusion in the report. Results and discussion: A meta-analysis of six studies concluded that CI vancomycin was associated with a lower relative risk of kidney injury than II therapy, although other studies reported equivocal findings. The results of several clinical studies suggest that CI vancomycin produces clinical outcomes that are comparable to II. Current vancomycin consensus guidelines promote aggressive dosing to achieve trough levels of 10-15 or 15-20 mg/ L, but also include recommendations to target a daily area under the curve (AUC 24 ) to minimum inhibitory concentration (MIC) ratio of at least 400. Because vancomycin is a non-concentrationdependent antibiotic, it might be more prudent to monitor steady-state serum concentrations (C ss ) during a CI rather than trough concentrations during II, due to the questionable correlation between measured trough concentration and AUC. From a pharmacokinetic/pharmacodynamic perspective, vancomycin dosing and monitoring practices associated with CI offer potentially greater reliability than II. A major disadvantage of CI involves the possibility of having to intravenously coadminister another drug that might not be compatible with vancomycin.What is new and conclusion: Continuous infusion vancomycin therapy offers the advantage of C ss monitoring, thus avoiding the variabilities associated with the timing of trough levels. Current CI practices include a loading dose of 15-20 mg/kg followed by an infusion of 10-40 mg/kg/day based on the patient's renal function, with a target C ss of about 20-30 mg/L. An alternative approach to weight-based (mg/kg) CI dosing is to calculate the dose from an estimation of the patient's vancomycin clearance (in L/h), derived from creatinine clearance (CrCl) via the equation (CrCl•0Á041) + 0Á22. The daily dose is then determined by multiplying vancomycin clearance (in L/h) by the desired AUC 24 . A new CI vancomycin dosing chart includes clearance-based dosing recommend...

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

“…Saugel et al . reported giving loading doses of 1000 mg or 1250 mg, followed by a CI rate of 60 mg/h.…”

Section: Resultsmentioning

confidence: 99%

Section: What Is Known and Objectivementioning

confidence: 99%

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The pharmacokinetic/pharmacodynamic rationale for administering vancomycin via continuous infusion

2015

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“…Loading doses of 25-30 mg/kg have been recommended for critically ill patients with MRSA infections ( Rybak et al 2009b ). Recent intervention studies have shown the need for such doses to reach suffi cient target levels during the fi rst days of vancomycin treatment in intensive care patients (Saugel et al 2013 ;Truong et al 2012 ).…”

Section: Clinical Vignette 121: Tdm Of Vancomycin Administered By Comentioning

confidence: 99%

Glycopeptides

Gyssens

2013

Fundamentals of Antimicrobial Pharmacokinetics and Pharmacodynamics

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Glycopeptides are a class of antibiotic drugs that is composed of glycosylated cyclic or polycyclic nonribosomal peptides. Older molecules used in clinical practice are vancomycin and teicoplanin. Oritavancin, dalbavancin, and telavancin belong to the subclass of lipoglycopeptides. Glycopeptides inhibit bacterial cell wall peptoglycan synthesis of aerobic and anaerobic Gram-positive bacteria. Glyco (lipo)peptides are not absorbed orally and have to be administered intravenously. In this chapter, the pharmacokinetics (Pk) and the pharmacodynamics (Pd) of the glycopeptides are studied. Pk in serum as well as protein binding and elimination are reviewed. Pharmacodynamic data include MICs of Gram-positive bacteria, PK/Pd effects in in vitro systems, animal models and human studies. Adverse effects of glycopeptides on the host are concentration related nephro-and ototoxicity. In the past, because of fear of toxicity, the older glycopeptides have been underdosed in many settings. The implementation of Pk/Pd knowledge into clinical practice by e.g. administering higher doses of vancomycin and teicoplanin and using continuous infusion of vancomycin is urgently needed. This chapter contains clinical vignettes showing the benefi t of Therapeutic Drug Monitoring of glycopeptides.

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PK / PD and the Drug Delivery Regimen for Infusion in the Critical Care Setting

Sime

Roberts

2021

Drug Delivery Approaches

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Continuous intravenous administration of vancomycin in medical intensive care unit patients

Cited by 51 publications

References 19 publications

The pharmacokinetic/pharmacodynamic rationale for administering vancomycin via continuous infusion

The pharmacokinetic/pharmacodynamic rationale for administering vancomycin via continuous infusion

Glycopeptides

PK / PD and the Drug Delivery Regimen for Infusion in the Critical Care Setting

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