Development and Validation of a Novel Vancomycin Dosing Nomogram for Achieving High-Target Trough Levels at 2 Canadian Teaching Hospitals

Thalakada, Rosanne; Legal, Michael; Lau, Tim T Y; Luey, Tiffany; Batterink, Josh; Ensom, Mary H H

doi:10.4212/cjhp.v65i3.1140

Cited by 14 publications

(22 citation statements)

References 15 publications

(19 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This may be the case for the Thalakada et al nomogram as well. The nomogram developed by Thalakada et al was designed to achieve troughs between 15 and 20 mcg/mL only, and a majority (86%) of patients included in the nomograms development had normal renal function, with serum creatinine measurements less than or equal to 1.6 mg/L [12]. It is also important to note that rounding was permitted within the Thalakada et al study.…”

Section: Discussionmentioning

confidence: 99%

“…Currently, several dosing strategies that have been published aimed at achieving these higher trough levels, each with varying limitations [10–12]. The nomogram by Kullar et al was designed to achieve troughs between 15 and 20 mcg/mL and was found to be effective in 58% of patients in which it was studied [10].…”

Section: Introductionmentioning

confidence: 99%

“…Also, no adjustment was made to the dosing protocol if the patient was obese or nonobese. The last, the nomogram by Thalakada et al utilized multiple regression analysis in order to provide equations for calculating a dosing interval, using age and serum creatinine as variables, which aimed at achieving a vancomycin trough of 15–20 mcg/mL [12]. It was found to be effective in 56% of patients.…”

Section: Introductionmentioning

confidence: 99%

“…This nomogram only addresses the vancomycin dosing interval that is required, and it can only be used to achieve trough concentrations between 15 and 20 mcg/mL. Also, a majority of patients included in the development of the nomogram (86%) had initial serum creatinine measurements between 0.5 and 1.6 mg/L, limiting the range of renal function to which the nomogram can be generalized [12]. …”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Prospective Trial of a Novel Nomogram to Achieve Updated Vancomycin Trough Concentrations

Wesner

Brackbill

Coyle

et al. 2013

Interdisciplinary Perspectives on Infectious Diseases

View full text Add to dashboard Cite

Purpose. To determine if the use of a novel vancomycin nomogram predicts dosing regimens that achieve target trough concentrations equal to or more accurate than dosing regimens calculated using traditional pharmacokinetic calculations, evaluate the incidence of subtherapeutic and supratherapeutic troughs, and assess pharmacist's impressions of the nomogram. Methods. Prospective, open-label study in 473 patients who had a new order for vancomycin and were >18 years of age and ≤120 kg. Patients were randomized to the active group, dosed using the nomogram, or to the control group, dosed using traditional pharmacokinetic calculations already in place at our institution. Results. Patients dosed via nomogram were within the appropriate trough range in 44% of cases compared to 33% in the control group (P = 0.014). Vancomycin troughs less than 10 mcg/mL were significantly decreased with the use of nomogram (P = 0.032). Incidence of supratherapeutic troughs, greater than 20 mcg/mL, was not significantly different between groups (P = 0.706), and pharmacists agreed that the nomogram was easy to use and saved their time. Conclusions. A novel vancomycin nomogram was prospectively validated and found to be more effective than traditional pharmacokinetic dosing. The nomogram is being implemented as the standard dosing protocol at our institution.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Prospective Trial of a Novel Nomogram to Achieve Updated Vancomycin Trough Concentrations

Wesner

Brackbill

Coyle

et al. 2013

Interdisciplinary Perspectives on Infectious Diseases

View full text Add to dashboard Cite

show abstract

“…[10][11][12][13] The nomogram published in North America, developed by Kullar and colleagues, was the first nomogram to target trough concentrations of 15 to 20 mg/L. 10 This prospective study did not have a control group, but it analyzed achievement of target trough concentrations and rates of nephrotoxicity within a population of patients.…”

mentioning

confidence: 99%

Evaluation of the Safety of a Vancomycin Nomogram Used to Achieve Target Trough Concentrations

O’Brien

Mok

2015

Hosp Pharm

View full text Add to dashboard Cite

Background: Dosing vancomycin to achieve target concentrations of 15 to 20 mg/L has been recommended for select infections. To date, few vancomycin nomograms designed to target these higher concentrations have been published, and only one has been published in North America. Based on the success of this nomogram in developing empiric vancomycin regimens that achieve higher target trough concentrations with low rates of nephrotoxicity, a vancomycin nomogram targeting concentrations of 15 to 20 mg/L was developed and implemented at Emory University Hospital and Emory University Hospital Midtown. Objective: To evaluate the impact of a vancomycin-dosing nomogram on the incidence of vancomycin-associated nephrotoxicity and the time to achieve targeted trough concentrations. Methods: A retrospective chart review of 200 patients who received vancomycin dosed to achieve target trough serum concentrations of 15 to 20 mg/L was performed. Results: After implementation of the vancomycin nomogram, no statistically significant difference in incidence of vancomycin-associated nephrotoxicity was found (14% vs 16%; P = .197). Fewer patients had an initial vancomycin trough concentration within target range (29.1% vs 21.7%; P < .001). Adherence to the nomogram was poor, with only 41% of patients being dosed per the nomogram's recommendations. Conclusion: Based on our results, implementation of a vancomycin dosing nomogram had no impact on the incidence of nephrotoxicity, and significantly fewer patients had an initial vancomycin trough within the target range of 15 to 20 mg/L. The clinical utility of a vancomycin dosing nomogram is still to be determined.

show abstract

Vancomycin therapeutic drug monitoring and population pharmacokinetic models in special patient subpopulations

Monteiro

Hahn

Gonçalves

et al. 2018

Pharmacology Res & Perspec

View full text Add to dashboard Cite

Vancomycin is a fundamental antibiotic in the management of severe Gram‐positive infections. Inappropriate vancomycin dosing is associated with therapeutic failure, bacterial resistance and toxicity. Therapeutic drug monitoring (TDM) is acknowledged as an important part of the vancomycin therapy management, at least in specific patient subpopulations, but implementation in clinical practice has been difficult because there are no consensus and agglutinator documents. The aims of the present work are to present an overview of the current knowledge on vancomycin TDM and population pharmacokinetic (PPK) models relevant to specific patient subpopulations. Based on three published international guidelines (American, Japanese and Chinese) on vancomycin TDM and a bibliographic review on available PPK models for vancomycin in distinct subpopulations, an analysis of evidence was carried out and the current knowledge on this topic was summarized. The results of this work can be useful to redirect research efforts to address the detected knowledge gaps. Currently, TDM of vancomycin presents a moderate level of evidence and practical recommendations with great robustness in neonates, pediatric and patients with renal impairment. However, it is important to investigate in other subpopulations known to present altered vancomycin pharmacokinetics (eg neurosurgical, oncological and cystic fibrosis patients), where evidence is still unsufficient.

show abstract

Development and Validation of a Novel Vancomycin Dosing Nomogram for Achieving High-Target Trough Levels at 2 Canadian Teaching Hospitals

Cited by 14 publications

References 15 publications

Prospective Trial of a Novel Nomogram to Achieve Updated Vancomycin Trough Concentrations

Prospective Trial of a Novel Nomogram to Achieve Updated Vancomycin Trough Concentrations

Evaluation of the Safety of a Vancomycin Nomogram Used to Achieve Target Trough Concentrations

Vancomycin therapeutic drug monitoring and population pharmacokinetic models in special patient subpopulations

Contact Info

Product

Resources

About