Evaluation of a vancomycin dosing nomogram in obese patients weighing at least 100 kilograms

Abstract

Background:There remains variability in both practice and evidence related to optimal initial empiric dosing strategies for vancomycin.Objective:Our primary objective was to describe the percentage of obese patients receiving vancomycin doses consistent with nomogram recommendations achieving targeted initial steady-state serum vancomycin concentrations. Secondary objectives were to describe the primary endpoint in subgroups based on patient weight and estimated creatinine clearance, to describe the rate of supratherapeutic vancomycin accumulation following an initial therapeutic trough concentration, and to describe the rate of vancomycin-related adverse events.Methods:This single-center, IRB-approved, retrospective cohort included adult patients ≥ 100 kilograms total body weight with a body mass index (BMI) >30 kilograms/m2 who received a stable nomogram-based vancomycin regimen and had at least one steady-state vancomycin trough concentration. Data collected included vancomycin regimens and concentrations, vancomycin indication, serum creatinine, and vancomycin-related adverse events. Patients were divided into two cohorts by goal trough concentration: 10-15 mcg/mL and 15-20 mcg/mL.Results:Of 325 patients screened, 85 were included. Goal steady-state concentrations were reached in 42/85 (49.4%) of total patients.Conclusions:Achievement of initial steady-state vancomycin serum concentrations in the present study (approximately 50%) was consistent with the use of published vancomycin dosing nomograms.

Experience of Vancomycin Therapeutic Drug Monitoring in Two Multidisciplinary Hospitals in Latvia

“…Over time, to improve vancomycin TDM, various medical organizations and competent authorities have also developed clinical practice guidelines [ 7 , 8 ]. However, despite efforts, proper adaptation of vancomycin therapy, including adequate TDM, remains a major challenge of successful treatment in many hospitals.…”

Comparing Two Equations for Estimation of Kidney Function (Cockcroft-gault and Glomerular Filtration Rate Assessment in Liver Disease) for Vancomycin Dosing in Adult Liver Transplant Recipients: a Pilot, Randomized Clinical Trial

“…Patients with estimated GFR of less than 15mL/min/1.73m 2 (16, 17), re-transplantation or simultaneous kidney and liver transplantation (15), coadministration of oral vancomycin(18), change in vancomycin dose before obtaining drug levels (19), need for albumin administration within past two days (20), receiving medications which interact with sCr assay (such as cephalosporins, cimetidine, high dose vitamin C and catecholamines) (21)(22)(23)(24), pregnant and lactating women were excluded from the study (25).…”

Comparing two equations for estimation of kidney function (Cockcroft-Gault and Glomerular Filtration Rate Assessment in Liver Disease) for vancomycin dosing in adult liver transplant recipients: a pilot, randomized clinical trial

“…The exclusion criteria were as follows: patients with eGFR of less than 15mL/min/1.73m 2 , 13,14 re-transplantation or simultaneous kidney and liver transplantation, 12 co-administration of oral vancomycin, 15 change in vancomycin dose before obtaining drug levels, 16 need for albumin administration within past two days, 17 receiving medications which interact with sCr assay (such as cephalosporins, cimetidine, high dose vitamin C and catecholamines), [18][19][20][21] pregnant and lactating women. 22 The study was conducted in the liver transplantation ward of Imam Khomeini Hospital Complex, affiliated with Tehran University of Medical Sciences, Tehran, Iran, from September 2019 to February 2021. All patients in this study received their organs from deceased donors.…”