Performance of a vancomycin dosage regimen developed for obese patients

Reynolds, David C.; Waite, Laura; Alexander, Donald P.; DeRyke, C Andrew

doi:10.2146/ajhp110324

Cited by 47 publications

(60 citation statements)

References 20 publications

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“…However, the mean creatinine and eGFR values measured at the completion of antibiotic therapy indicated that the nephrotoxicity had resolved for the most part. These results fall within previously reported nephrotoxicity ranges of 2.9%-43% among similar populations [15,25,29,[32][33][34][35][36].…”

Section: Discussionsupporting

confidence: 91%

“…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 dosing protocol (vancomycin 15 mg/kg intravenously [IV] every 8-12 h) with a revised dosing protocol (i.e., 10 mg/kg IV every 12 h or 15 mg/kg every 24 h) in a cohort of 138 obese patients [29]. The authors concluded that the revised protocol improved the attainment of target trough concentrations with minimal nephrotoxicity compared with the original protocol.…”

Section: Davies Et Almentioning

confidence: 99%

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Vancomycin-Associated Nephrotoxicity: The Obesity Factor

Davies

Efird

Guidry

et al. 2015

Surgical Infections

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 78%

Section: Davies Et Almentioning

confidence: 99%

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Vancomycin-Associated Nephrotoxicity: The Obesity Factor

Davies

Efird

Guidry

et al. 2015

Surgical Infections

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“…For obese patients, the most widespread recommendation is an initial dose based on ABW, not exceeding 2 g for each dose, and adjusting the subsequent doses based on serum vancomycin concentrations to achieve therapeutic levels (4). However, Reynolds et al (63) found that these dosages are associated with a high risk of above-target trough levels. They compared the IDSA-based protocol with a revised one in 74 and 64 obese patients, respectively, reporting that the revised protocol better enabled them to reach trough concentrations of 10 to 20 mg/liter (36% versus 59% in IDSA-based versus revised protocol; P ϭ 0.006).…”

Section: Vancomycin and Obesitymentioning

confidence: 99%

Optimizing the Clinical Use of Vancomycin

Álvarez

López-Cortés

Molina

et al. 2016

Antimicrob Agents Chemother

183

124

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Pharmacists published specific guidelines about vancomycin dosage and monitoring. However, these guidelines have not been updated in the past 6 years. This review analyzes the new available information about vancomycin published in recent years regarding pharmacokinetics and pharmacodynamics, serum concentration monitoring, and optimal vancomycin dosing in special situations (obese people, burn patients, renal replacement therapy, among others). Vancomycin efficacy is linked to a correct dosage which should aim to reach an area under the curve (AUC)/MIC ratio of >400; serum trough levels of 15 to 20 mg/liter are considered a surrogate marker of an AUC/MIC ratio of >400 for a MIC of <1 mg/liter. For Staphylococcus aureus strains presenting with a MIC >1 mg/liter, an alternative agent should be considered. Vancomycin doses must be adjusted according to body weight and the plasma trough levels of the drug. Nephrotoxicity has been associated with target vancomycin trough levels above 15 mg/liter. Continuous infusion is an option, especially for patients at high risk of renal impairment or unstable vancomycin clearance. In such cases, vancomycin plasma steady-state level and creatinine monitoring are strongly indicated. Vancomycin has traditionally been used as a first-line agent for treating methicillin-resistant Staphylococcus aureus (MRSA) and other Gram-positive beta-lactam-resistant bacteria (1), which are frequent etiologies of severe health-related infections (2, 3).Although the effectiveness of vancomycin is supported by more than 5 decades of use and multiple studies, the clinical and microbiological scenario in which it is used is always changing. Attaining an appropriate dosage of vancomycin for S. aureus infections might be difficult due to the clinical impact of the creep in the MIC of vancomycin and heteroresistance among MRSA strains, or due to complex pharmacokinetic and pharmacodynamic (PK/PD) situations. In this context, the American Society of Health-System Pharmacists (ASHP), the Infectious Diseases Society of America (IDSA), and the Society of Infectious Diseases Pharmacists (SIDP) introduced a practice guideline in 2009 (4), marking a milestone in vancomycin therapy. However, several questions, such as the optimal dosing in some special clinical situations (e.g., with renal replacement therapies or in burn patients or obese patients), the role of continuous infusion, or the renal toxicity when the suggested vancomycin serum levels are achieved, remain unanswered. The present review mainly focuses on these issues. VANCOMYCIN PHARMACODYNAMICS AND ITS IMPLICATIONS FOR DRUG MONITORINGThe killing effect of vancomycin is characterized by a slow mode of action and is further hampered by a large bacterial inoculum, a stationary growth phase, and anaerobic conditions (5, 6). Although several pharmacodynamic parameters have been proposed to determine vancomycin activity, data from experimental and clinical studies have selected the area under the curve (AUC)/ MIC ratio as the best parameter to predict the...

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“…1 In response to the IDSA guidelines, several protocols have been published to help clinicians achieve the targets set by the IDSA. [2][3][4][5][6][7][8] Four protocol studies reported clinical experience with dosing vancomycin in obese patients. 2,4,6,8 None of these protocols reliably meet the IDSA objectives when applied to obese patients, and 3 of the clinical reports suggest that obese patients require a strategy different from that in nonobese patients to achieve and maintain vancomycin trough concentrations within the target range.…”

Section: Introductionmentioning

confidence: 99%