Correlation of vancomycin clearance and creatinine clearance: unreliability for predicting initial dosing in neutropenic haematological patients

Soto, Juan I.; Alsar, M J; Chantal, P; Sacristán, J A

doi:10.1093/jac/32.6.920

Cited by 6 publications

(5 citation statements)

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“…46 Also, Soto et al reported a poor correlation between creatinine clearance and vancomycin clearance. 47 In a more homogenous group of patients such as those with neutropenia secondary to hematological malignancy, variations in teicoplanin pharmacokinetics are likely to be less than in other patients which is similar to previous observations with aminoglycosides. 4s…”

Section: Discussionsupporting

confidence: 83%

Retrospective review of serum teicoplanin concentrations in clinical trials and their relationship to clinical outcome

MacGowan

White

Reeves

et al. 1996

Journal of Infection and Chemotherapy

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Section: Discussionsupporting

confidence: 83%

Retrospective review of serum teicoplanin concentrations in clinical trials and their relationship to clinical outcome

MacGowan

White

Reeves

et al. 1996

Journal of Infection and Chemotherapy

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“…9 Finally, the altered disposition of vancomycin in neutropenic patients combined with the fact that these patients are at high risk for developing gram positive infections has led to higher than anticipated dosage regimens. [10][11][12][13] A model has suggested enhanced vancomycin clearance and volume of distribution in patients with hematological malignancies. 13 A similar phenomenon has also been observed with the aminoglycoside antibiotics in malignancy.…”

Section: Introductionmentioning

confidence: 99%

Characterization of vancomycin pharmacokinetics in the adult acute myeloid leukemia population

Jarkowski

Forrest

Sweeney

et al. 2011

J Oncol Pharm Pract

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Current vancomycin dosing guidelines in our acute myeloid leukemia population too often achieve suboptimal initial drug concentrations. Our aim was to assess vancomycin pharmacokinetic parameters in acute myeloid leukemia patients and develop an improved dosing equation to attain more accurate initial therapeutic trough levels. Acute myeloid leukemia patients receiving vancomycin for a presumed or documented gram positive infection were eligible. Patients hospitalized in the intensive care unit, those with creatinine clearance <30 mL/min or with limb amputation were excluded. Three samples were collected at the following post-infusion time ranges: 1 h, 3-8 h, and 8-24 h post-infusion, contingent on the dosing interval. Pharmacokinetic data were then fit using a Bayesian-based population pharmacokinetic model. A total of 25 acute myeloid leukemia patients were studied with a mean volume in the central compartment (Vc; L/65 kg), volume of distribution at steady state (Vss; L/65 kg) and distributional clearance (CLd; L/h/65 kg) of 15, 38.9, and 9.32, respectively. CLslope was 0.59 (mg of vancomycin clearance per unit of creatinine clearance in mL/min); this value is 21.4% lower than the established literature value (0.75). The derived equation, based upon these values, was reasonably precise at achieving the desired trough concentration using a priori dosing. The mean (CV%) of the achieved trough was 94% (29%) with a range of 66-188%; 3/25 at <75% and >125%]. We have established that the derived dosing equation can place ≈ 75% of adult acute myeloid leukemia patients at vancomycin trough levels within 75-125% of the target trough level.

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“…In 18 studies, 17,18,20,[22][23][24][25][26][27][28][29][30][31][34][35][36][37][38] vancomycin was infused intermittently, and 2 studies adopted continuous infusion, 19,21 whereas the remaining 1 conference abstract did not report the specific dosing regimen. 16 For single-arm studies, nine studies included neutropenic hematologic patients consecutively, 16,18,20,21,26,28,31,34,35 while 6 studies included patients with hematologic malignancies without distinguishing neutropenia from non-neutropenia. 17,19,22,27,29,38 Additionally, another two studies included hospitalized patients and took neutropenia as a risk factor.…”

Section: Resultsmentioning

confidence: 99%

“…Four studies 25,28,30,31 reported the potential effect of neutropenia on CL CR. Hirai et al 30 conducted a single-center retrospective study in 292 patients with normal serum creatinine concentration, and demonstrated that febrile neutropenia was an independent risk factor of ARC (OR: 2.76; 95% CI: 1.11-6.67; P = 0.0254).…”

Section: The Potential Effect Of Neutropenia On Creatinine Clearance (Cl Cr )mentioning

confidence: 99%

“…Three studies evaluated the correlation between CLva and estimated CL CR solely. Soto et al 31 included 45 neutropenic (<1000/mm 3 ) hematologic patients and demonstrated that the correlation coefficient between CLva (106 ± 37 mL/min) and estimated CL CR (84.7 ± 32 mL/min) was 0.42. Le Normand et al 28 illustrated a poor correlation in neutropenic patients (100/mm 3 ) as well (n = 10, r = 0.281).…”

Section: The Potential Effect Of Neutropenia On Creatinine Clearance (Cl Cr )mentioning

confidence: 99%

See 1 more Smart Citation

<p>A Systematic Review of Vancomycin Dosing in Patients with Hematologic Malignancies or Neutropenia</p>

He¹,

Dong²,

Liu³

et al. 2020

IDR

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Objective: To provide a comprehensive review of vancomycin dosing in patients with hematologic malignancies or neutropenia. Methods: PubMed, Embase and the Cochrane Library were searched through April 2, 2020. Original studies relevant to vancomycin dosing regimen in adults with hematologic malignancies or neutropenia were included. No restriction was applied in study design and language. A descriptive analysis was performed. Results: Twenty-three studies were included eventually, of which eighteen were case series studies, four were cohort studies and another one was a randomized controlled trial. Five case series studies made a clinical audit of conventional vancomycin dosing in patients with malignancies or neutropenia, showing that the proportion of patients with sub-therapeutic trough levels remained high, ranging from 32% to 88%. Seven case series studies and four cohort studies demonstrated that vancomycin clearance (CLva) tended to be higher in patients with hematologic malignancies or neutropenia, whereas volume of distribution (V) seemed to be comparable to the control group. Five studies proposed individualized initial dosing regimen per the pharmacokinetic changes; however, no prospective validation has been conducted in clinical setting. Additionally, four case series studies suggested that the correlation between vancomycin clearance and estimated creatinine clearance was relatively poor, bringing a great challenge to proper dosing strategy. A randomized controlled trial stated that therapeutic drug monitoring (TDM) of vancomycin could decrease the incidence of nephrotoxicity in immunocompromised febrile patients with hematologic malignancies. Conclusion:The available evidence indicates that conventional vancomycin dosing leads to suboptimal concentration in patients with hematologic malignancy or neutropenia. TDM accompanied by pharmacokinetic interpretation can decrease the risk of nephrotoxicity. The individualization of the initial dosing regimen and mechanisms of augmented clearance require further research.

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Correlation of vancomycin clearance and creatinine clearance: unreliability for predicting initial dosing in neutropenic haematological patients

Cited by 6 publications

References 0 publications

Retrospective review of serum teicoplanin concentrations in clinical trials and their relationship to clinical outcome

Retrospective review of serum teicoplanin concentrations in clinical trials and their relationship to clinical outcome

Characterization of vancomycin pharmacokinetics in the adult acute myeloid leukemia population

<p>A Systematic Review of Vancomycin Dosing in Patients with Hematologic Malignancies or Neutropenia</p>

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