Determinants of early inadequate vancomycin concentrations during continuous infusion in septic patients

New Regimen for Continuous Infusion of Vancomycin in Critically Ill Patients

“…Individual analyses showed significant differences (P Ͻ 0.05) from vancomycin concentrations at a creatinine clearance of Ͻ25 ml/min (a), 25 to 50 ml/min (b), or 51 to 80 ml/min (c). of patients after 24 h of treatment (7). Similarly, De Waele et al…”

“…For non-ICU patients with severe MRSA infections, standard regimens of vancomycin (15 mg/kg followed by 30 mg/kg/day) given by CI achieved target drug concentrations within 36 h from the initiation of therapy (5). Nevertheless, recent studies have underlined that for critically ill patients, this drug regimen is associated with a high proportion of individuals with insufficient drug concentrations, because of significant changes in vancomycin PK (7,21). Ocampos-Martinez et al found that this standard regimen resulted in vancomycin concentrations of Ͻ20 mg/liter in Ͼ50% Chi-square analysis for trend yielded a P value of 0.02.…”

“…Nevertheless, because of significant changes in vancomycin pharmacokinetics (PK) during critical illness, such as increased volume of distribution (V) and augmented clearance, the standard CI regimen (e.g., a loading dose of 15 mg/kg of body weight, followed by 30 mg/kg over 24 h for patients with normal renal function) (5) has been associated with inadequate drug concentrations in a high proportion of septic patients in the first 2 days of therapy (7). As such, Roberts et al (8), using a population PK analysis, suggested that a vancomycin loading dose of 35 mg/kg, followed by daily doses adjusted to creatinine clearance (CrCL, ranging from 7 to 45 mg/kg/day), would rapidly achieve adequate drug concentrations in critically ill patients.…”

Treatment options for methicillin-resistant Staphylococcus aureus (MRSA) infection: Where are we now?

“…A 25-30 mg/kg loading dose is recommended for critically ill patients. However, increased clearance and the need for haemofiltration, both common in critically ill patients, are associated with low serum concentrations [49][50][51][52] and difficulty in early achievement of the target.…”

Problemos Gydant Vankomicinu Kritinių Būklių Pacientus

“…Diskutuojama, ar didelė vankomicino koncentracija kraujyje sukelia inkstų pažeidimą, ar jis išsi-vysto anksčiau ir dėl jo padidėja antibiotiko koncentracija [13].Klausos pažeidimas daugeliu atvejų taip pat išsivysto pacientams, kurie jau prieš tai turėjo klausos sutrikimų arba buvo gydomi kitais ototoksiškumu pasižyminčiais vaistais [12].Taigi, skiriant vankomiciną, jo koncentracijos plazmoje sekimas tampa vienu svarbiausių rodiklių kritinių būklių pacientams. Per maža šio antibiotiko koncentracija plazmoje yra siejama su padidėjusiu glomerulų filtracijos greičiu, kai medžiagų, esančių kraujyje, pašalinimas per inkstus greitėja [15][16][17]. Tai ypač svarbu kritinės būklės pradžioje, kai glomerulų hiperfiltracija nustatoma dažniau-siai [18].…”