Implementation of a two-point pharmacokinetic AUC-based vancomycin therapeutic drug monitoring approach in patients with methicillin-resistant Staphylococcus aureus bacteraemia

Mogle, Bryan T.; Steele, Jeffrey; Seabury, Robert W.; Dang, Utkarsh J.; Kufel, Wesley D

doi:10.1016/j.ijantimicag.2018.08.024

Cited by 48 publications

(43 citation statements)

References 33 publications

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“…Circuits were primed with ≈600 mL normal saline. Cannula size was based on patients' blood vessel diameter [14][15][16][17]…”

Section: Ecmo Datamentioning

confidence: 99%

“…The pink person represents the non-ECMO patients. The blue and red persons represent ECMO patients; 'd' indicates 'dose' on the timeline All patients were sampled Patients before ECMO weaning were sampledPatients after ECMO weaning were sampled of MRSA as 0.5 or 1 µg/mL and set AUC 24 /MIC > 400 µg h/mL as a cut-off point for probability of target attainment (PTA) threshold,14 AUC 0-24 > 700 µg h/mL was the cut-off point for probable nephrotoxicity 15,16. Under conditions of infection with MRSA having an MIC > 1.5 µg/mL, antibiotics such as Linezolid could be good alternatives for treatment.…”

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confidence: 99%

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Influence of venovenous extracorporeal membrane oxygenation on pharmacokinetics of vancomycin in lung transplant recipients

et al. 2020

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What is known and objective The influence of venovenous extracorporeal membrane oxygenation (VV‐ECMO) on the population pharmacokinetics (PPK) of vancomycin in recipients after lung transplantation (LTx) is unknown. We investigated whether VV‐ECMO influences vancomycin PPK and determined optimal recommended dosage for patients after LTx. Methods We tested vancomycin serum concentration and calculated PPK parameters using NONMEM. To check for any potential influence of ECMO on vancomycin PK, we compared ECMO patients with a non‐ECMO patient control group, and patients before and after ECMO weaning as self‐control to analysed changes in vancomycin PK. Monte Carlo dosing simulation was conducted to explore vancomycin dosing regimens. Results Nineteen ECMO and 6 non‐ECMO lung transplant recipients were enrolled. Vancomycin serum concentrations did not significantly differ between patients with and without ECMO support. Comparison of separate vancomycin population pharmacokinetic models showed that ECMO patients had smaller peripheral compartment volume of distribution (V2) [Estimate (relative standard error, RSE, %) 19.7 (12) vs. 22 (17) L, P = .003] than non‐ECMO patients. For treatment of methicillin‐resistant Staphylococcus aureus (MRSA) infections with MIC ≤ 0.5 µg/mL, venous infusion of 400 mg vancomycin every 8 hours was recommended. For MRSA infection with MIC ≤ 1 µg/mL, the proposed dosage was 600 mg every 8 hours. What is new and conclusion Venovenous extracorporeal membrane oxygenation slightly alters vancomycin PK but does not significantly impact vancomycin serum concentration in patients after LTx. Dose adjustment is not necessary for VV‐ECMO support. Specific vancomycin dosing regimens with lower nephrotoxicity may benefit LTx recipients with VV‐ECMO.

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“…Circuits were primed with ≈600 mL normal saline. Cannula size was based on patients' blood vessel diameter [14][15][16][17]…”

Section: Ecmo Datamentioning

confidence: 99%

mentioning

confidence: 99%

Influence of venovenous extracorporeal membrane oxygenation on pharmacokinetics of vancomycin in lung transplant recipients

et al. 2020

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“…A recent study of novel rabbit models of neonatal coagulase‐negative Staphlococcus central‐line associated bloodstream infections demonstrated that an AUC 24 /MIC >400 was associated with maximal bacterial killing and suppression of the emergence of vancomycin resistance . However, determination of AUC involves multiple blood samples and a linear‐trapezoidal formula or pharmacokinetic software that needs further pharmacokinetic modeling, understanding, and personnel training . These may contribute to limited use of AUC‐based vancomycin monitoring in routine clinical practice.…”

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confidence: 99%

“…The equation‐based approach for vancomycin AUC monitoring has been adopted into clinical practice for adults. Its several advantages include reducing unnecessary adjustments of the vancomycin dose and improving clinical outcomes with less nephrotoxicity . However, data to support this approach in children remain limited.…”

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confidence: 99%

“…6,7 However, determination of AUC involves multiple blood samples and a linear-trapezoidal formula or pharmacokinetic software that needs further pharmacokinetic modeling, understanding, and personnel training. 8 These may contribute to limited use of AUC-based vancomycin monitoring in routine clinical practice. Serum trough concentration (C trough ) is therefore recommended instead as a practical surrogate marker for vancomycin monitoring.…”

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confidence: 99%

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Optimizing Vancomycin Use Through 2‐Point AUC‐Based Therapeutic Drug Monitoring in Pediatric Patients

Suchartlikitwong

Anugulruengkitt

Wacharachaisurapol

et al. 2019

The Journal of Clinical Pharma

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The 24‐hour vancomycin area under the serum concentration‐time curve (AUC24) divided by the minimum inhibitory concentration (MIC) (AUC24/MIC) is more closely related to patient outcomes than serum trough concentrations (Ctrough). Two‐point simplified equations for calculating AUC based on serum peak concentrations (Cpeak) and Ctrough, named equation A (EqA) and equation B (EqB), have recently been adopted into clinical use for adult pediatric patients. We aimed to find the agreement between predicted AUC24 using the reference method (ref) relative to EqA and EqB and the correlation between Ctrough and AUC24. From June to December 2018, 43 pediatric patients with normal renal function, receiving 15 mg/kg of vancomycin intravenously every 6 hours, were enrolled. The pediatric patients’ median age was 2.2 years (range 0.1‐15.3). At steady state, vancomycin Cpeak and Ctrough were measured at 2 hours after infusion completion and within 30 minutes before the next dosing, respectively. AUC24 was estimated using ref, EqA, and EqB. From Bland‐Altman analysis, the 2 AUC24s estimated by ref and EqA showed less bias than those estimated by ref and EqB (bias 1.3 and –72.1 mg⋅h/L, respectively). Ctrough and AUC24 using either ref or EqA were correlated more closely (r2 = 0.94) than with EqB (r2 = 0.86). Assuming a vancomycin MIC of 1 mg/L, an AUC24 ≥400 mg⋅h/L was targeted. Regardless of the method used, AUC24 ≥400 mg⋅h/L was never seen with Ctrough <8 mg/L but was always seen with Ctrough >10 mg/L. In conclusion, EqA based on the 2 measured serum concentrations was sufficiently accurate for AUC24 estimation. Ctrough >10 mg/L correlated highly to AUC24 ≥400 mg⋅h/L.

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Evaluation of a Pilot Vancomycin Precision Dosing Advisory Service on Target Exposure Attainment Using an Interrupted Time Series Analysis

Stocker

Carland

Reuter

et al. 2020

Clin Pharma and Therapeutics

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Implementation of a two-point pharmacokinetic AUC-based vancomycin therapeutic drug monitoring approach in patients with methicillin-resistant Staphylococcus aureus bacteraemia

Cited by 48 publications

References 33 publications

Influence of venovenous extracorporeal membrane oxygenation on pharmacokinetics of vancomycin in lung transplant recipients

Influence of venovenous extracorporeal membrane oxygenation on pharmacokinetics of vancomycin in lung transplant recipients

Optimizing Vancomycin Use Through 2‐Point AUC‐Based Therapeutic Drug Monitoring in Pediatric Patients

Evaluation of a Pilot Vancomycin Precision Dosing Advisory Service on Target Exposure Attainment Using an Interrupted Time Series Analysis

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