Evaluation of a Once-Daily Vancomycin Regimen in an Outpatient Leukemia/Bone Marrow Transplant Clinic (OD-VANCO Study)

Luo, Cindy; Hussaini, Trana; Lacaria, Katie; Yeung, Janice; Lau, Tim T Y; Broady, Raewyn

doi:10.4212/cjhp.v67i4.1372

Cited by 2 publications

(5 citation statements)

References 16 publications

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“…Recently, Suzuki and co‐workers had proposed a target Ctrough of 11.5 mg/mL for febrile neutropenia in patients with hematological malignancies . The high‐dose, once‐daily vancomycin nomogram attained trough levels greater than 10 mg/L in only 21% of patients with leukemia and a substantial number of adverse drug reactions were observed leading to the nonrecommendation of such regimen for outpatient therapy …”

Section: Therapeutic Drug Monitoringmentioning

confidence: 99%

“…86 The high-dose, once-daily vancomycin nomogram attained trough levels greater than 10 mg/L in only 21% of patients with leukemia and a substantial number of adverse drug reactions were observed leading to the nonrecommendation of such regimen for outpatient therapy. 87 The "PPK Model review" found three studies in hematological patients. One was excluded because it was not a population model and the remaining two are described in Table 12.…”

Section: Hematologic Patientsmentioning

confidence: 99%

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

Monteiro

Hahn

Gonçalves

et al. 2018

Pharmacology Res & Perspec

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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.

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Section: Therapeutic Drug Monitoringmentioning

confidence: 99%

Section: Hematologic Patientsmentioning

confidence: 99%

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

show abstract

“…Therefore, twenty-one sets of clinical data were finally included. 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.…”

Section: Resultsmentioning

confidence: 99%

“…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. 30,36 Concerning comparative cohort studies, there were two studies comparing neutropenic patients with nonneutropenic patients, 23,25 and another 2 studies focused on the difference between hematologic malignant patients and control groups.…”

Section: Resultsmentioning

confidence: 99%

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<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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Evaluation of a Once-Daily Vancomycin Regimen in an Outpatient Leukemia/Bone Marrow Transplant Clinic (OD-VANCO Study)

Cited by 2 publications

References 16 publications

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

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

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

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