Determining vancomycin clearance in an overweight and obese population

Leong, Julie V. B.; Boro, Maureen S.; Winter, Michael E.

doi:10.2146/ajhp100410

Cited by 33 publications

(20 citation statements)

References 16 publications

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“…We present one of the largest cohorts published to date evaluating vancomycin, obesity, and nephrotoxicity [13][14][15][16][17][18][19][29][30][31]. Our study observed a 21% incidence of nephrotoxicity (obese = 18% vs. lean = 23%) among infectious episodes treated with vancomycin and a 12% incidence of new-onset hemodialysis (obese = 10% vs. lean = 14%).…”

Section: Discussionmentioning

confidence: 78%

Vancomycin-Associated Nephrotoxicity: The Obesity Factor

Davies

Efird

Guidry

et al. 2015

Surgical Infections

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Section: Discussionmentioning

confidence: 78%

Vancomycin-Associated Nephrotoxicity: The Obesity Factor

Davies

Efird

Guidry

et al. 2015

Surgical Infections

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“…Richardson et al [20] reported that increasing BMI categories were associated with a C min >20 μg/mL. Leong et al [21] demonstrated that an adjusted body weight was more accurate at predicting vancomycin clearance in obese individuals.…”

Section: Discussionmentioning

confidence: 99%

Vancomycin loading dose is associated with increased early clinical responses without attainment of initial target trough concentration at a steady state in patients with normal renal function

Takesue

Nakajima

Ichiki

et al. 2019

Preprint

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Background Vancomycin therapeutic guidelines suggest a loading dose of 25–30 mg/kg for seriously ill patients. However, high-quality data to guide the use of loading dose are lacking. Evaluate whether a loading dose 1) achieves a target trough concentration (Cmin) at steady state and 2) improves early clinical responses. Methods Patients with an estimated glomerular filtration rate ≥90 mL/min/1.73 m2 were included. A loading dose of 25 mg/kg vancomycin followed by 15 mg/kg twice daily was compared with traditional dosing. A Cmin sample was obtained before the fifth dose. An early clinical response 48–72 h after the start of therapy and clinical success at end of therapy (EOT) was evaluated in patients with methicillin-resistant Staphylococcus aureus (MRSA), methicillin-resistant coagulase-negative Staphylococci, or Enterococcus faecium. Results There was no significant difference in Cmin between the regimen with and without a loading dose (median: 10.4 µg/mL and 10.2 µg/mL, P=0.538). Proportions of patients achieving 10–20 µg/mL and 15–20 µg/mL were 56.9% and 5.6%, respectively, in patients with a loading dose. Although there was no significant difference in success rate at EOT between groups, loading dose was associated with increased early clinical responses for all infections [adjusted odds ratio (OR): 4.829, 95% confidence interval (CI): 1.441–16.188] and MRSA infections (OR: 10.851, 95% CI: 1.701–69.233). Increased adverse events were not observed with the loading dose. Study limitations included no Cmin measurements within 24 hours, and the inclusion of less critically ill patients. Conclusions Although the loading dose did not achieve optimal Cmin at steady state, a higher early clinical response was obtained compared with traditional dosing.

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“…Previous studies have identified greater CLvanc in obese patients with normal serum creatinine [ 8 , 9 , 15 ]. As obese patients have a larger volume of distribution (Vd), they may have a higher CrCL and CLvanc.…”

Section: Discussionmentioning

confidence: 99%

Daily vancomycin dose requirements as a continuous infusion in obese versus non-obese SICU patients

2016

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BackgroundLimited data are available assessing vancomycin concentrations in obese critically ill patients. Currently, there are no studies evaluating dosing requirements in this population who receive vancomycin administered as a continuous infusion (CI). The aim of this study was to assess whether there was a difference in the weight-based maintenance dose required to reach a therapeutic vancomycin concentration at 24 hours when given as a CI in obese versus non-obese critically ill patients.MethodsA retrospective cohort study of adult obese patients admitted to the SICU between 2013 and 2015 receiving a vancomycin CI (CIV), and with 24-hour serum measurements were included. Obese patients (body mass index (BMI) ≥35 kg/m2) were matched with non-obese patients (BMI <30 kg/m2) based on renal function, age and acute physiology and chronic health evaluation (APACHE)-II score at admission. All patients in this study received a loading dose of 25 mg/kg then a maintenance dose based on renal function according to the protocol. The study was approved by the Institutional Review Board. The primary outcome was the weight-based total daily maintenance dose required to achieve a vancomycin level of 20 mg/L. The secondary endpoints included the achievement of a therapeutic level at 24 hours.ResultsTwenty-six matched pairs of patients met the inclusion criteria. Of these, 17 pairs had preserved renal function and 9 pairs required continuous venovenous hemofiltration. Mean BMI was 40.9 kg/m2 in obese and 24.8 kg/m2 in non-obese patients. To achieve a vancomycin concentration of 20 mg/L, the weight-based daily maintenance dose in obese patients was 25.6 mg/kg versus 43.8 mg/kg in non-obese patients (p <0.01). Therapeutic 24-hour levels were achieved in 24/26 obese versus 23/26 no-obese patients (p = 0.63). Mean 24-hour vancomycin level was 20.3 ± 3.81 mcg/ml in obese compared to 20.03 ± 3.79 mcg/ml in non-obese patients (p = 0.77). Mean daily maintenance doses required to achieve a level of 20 mcg/ml were 2961 ± 1670 mg in obese compared to 3189 ± 1600.69 mg in non-obese (p = 0.61).ConclusionsThe results of our study suggest that critically ill obese patients treated with CIV required a significantly lower maintenance dose per unit of body weight than non-obese patients to achieve the same target level.

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Determining vancomycin clearance in an overweight and obese population

Cited by 33 publications

References 16 publications

Vancomycin-Associated Nephrotoxicity: The Obesity Factor

Vancomycin-Associated Nephrotoxicity: The Obesity Factor

Vancomycin loading dose is associated with increased early clinical responses without attainment of initial target trough concentration at a steady state in patients with normal renal function

Daily vancomycin dose requirements as a continuous infusion in obese versus non-obese SICU patients

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