The Importance of Individualized Vancomycin Dosing to Ensure Optimal Exposure Early in Therapy

Zasowski, Evan J; Lodise, Thomas P.

doi:10.1002/jcph.1281

Cited by 4 publications

(3 citation statements)

References 17 publications

(75 reference statements)

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“…This likely explains the large proportion of isolates with a vancomycin MIC of 2 mg/L in this study; this limited our ability to fully control for phenotype. Finally, because only a small proportion of the patients were monitored by vancomycin AUC, we were unable to control for vancomycin exposure [36]. Given the fact that AUC-guided dosing was more common in the vancomycin + cefepime group and is associated with reduced vancomycin dose and exposure, it is implausible that AUC-guided dosing would explain the improved BSI clearance observed in the combination patients [28, 37].…”

Section: Discussionmentioning

confidence: 99%

The Impact of Concomitant Empiric Cefepime on Patient Outcomes of Methicillin-Resistant Staphylococcus aureus Bloodstream Infections Treated With Vancomycin

Zasowski

Trinh

Atwan

et al. 2019

Open Forum Infectious Diseases

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Background Data suggest that vancomycin + β-lactam combinations improve clearance of methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infections (BSIs). However, it is unclear which specific β-lactams confer benefit. This analysis evaluates the impact of concomitant empiric cefepime on outcomes of MRSA BSIs treated with vancomycin. Methods Retrospective cohort study of adults with MRSA BSI from 2006 to 2017. Vancomycin + cefepime therapy was defined as ≥24 hours of cefepime during the first 72 hours of vancomycin. The primary outcome was microbiologic failure, defined as BSI duration ≥7 days and/or 60-day recurrence. Multivariable logistic regression was used to evaluate the association between vancomycin + cefepime therapy and binary outcomes. Cause-specific and subdistribution hazard models were used to evaluate the association between vancomycin + cefepime and BSI clearance. Results Three hundred fifty-eight patients were included, 129 vancomycin and 229 vancomycin + cefepime. Vancomycin + cefepime therapy was independently associated with reduced microbiologic failure (adjusted odds ratio [aOR], 0.488; 95% confidence interval [CI], 0.271–0.741). This was driven by a reduction in the incidence of BSI durations ≥7 days (vancomycin + cefepime aOR, 0.354; 95% CI, 0.202–0.621). Vancomycin + cefepime had no association with 30-day mortality (aOR, 0.952; 95% CI, 0.435–2.425). Vancomycin + cefepime was associated with faster BSI clearance in both cause-specific (HR, 1.408; 95% CI, 1.125–1.762) and subdistribution hazard models (HR, 1.264; 95% CI, 1.040–1.536). Conclusions Concomitant empiric cefepime improved MRSA BSI clearance and may be useful as the β-lactam component of synergistic vancomycin + β-lactam regimens when empiric or directed gram-negative coverage is desired.

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Section: Discussionmentioning

confidence: 99%

The Impact of Concomitant Empiric Cefepime on Patient Outcomes of Methicillin-Resistant Staphylococcus aureus Bloodstream Infections Treated With Vancomycin

Zasowski

Trinh

Atwan

et al. 2019

Open Forum Infectious Diseases

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“…The fraction of patients with AUC 24 between 400 and 600 (mg.h)/L is calculated for each day as 1 minus the fraction of patients where the AUC 24 is below 400 (mg.h)/L minus the fraction of patients where the AUC 24 is above 600 (mg.h)/L. This target exposure window is a frequently reported target in the literature for the optimization of vancomycin therapy assuming a minimum inhibitory concentration ≤ 1 mg/L 11,12 . To avoid the optimization being driven by the most populated subgroup in the virtual patient population, we split up the calculation of the fitness criterion according to body mass index (< 18.5, < 30, or > 30 kg/m 2 ), age (< 50, < 75, or > 75 years), and eCL CR according to Cockcroft‐Gault 13 (< 50, < 120, or > 120 mL/min).…”

Section: Methodsmentioning

confidence: 99%

Genetic Algorithms as a Tool for Dosing Guideline Optimization: Application to Intermittent Infusion Dosing for Vancomycin in Adults

Colin

Eleveld

Thomson

2020

CPT Pharmacom & Syst Pharma

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This paper demonstrates the use of a genetic algorithm (GA) for the optimization of a dosing guideline. GAs are well-suited to derive combinations of doses and dosing intervals that go into a dosing guideline when the number of possible combinations rule out the calculation of all possible outcomes. GAs also allow for different constraints to be imposed on the optimization process to safeguard the clinical feasibility of the dosing guideline. In this work, we demonstrate the use of a GA for the optimization of intermittent vancomycin administration in adult patients. Constraints were placed on the dose strengths, the length of the dosing intervals, and the maximum infusion rate. In addition, flexibility with respect to the timing of the first maintenance dose was included in the optimization process. The GA-based optimal solution is compared with the Scottish Antimicrobial Prescribing Group vancomycin guideline. www.psp-journal.comGenetic Algorithm-Based Dosing Optimization Colin et al. www.psp-journal.com Genetic Algorithm-Based Dosing Optimization Colin et al.

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“…IoT-type devices that comprise thin sensors are the next step in point of care testing (POCT) and personalised medicine [ 37 ] for tailored diagnostics and therapy that addresses each patient’s needs based on their specific background, disease prognosis, and assessed risks [ 38 ]. Despite complex and multifactorial difficulties [ 39 ], considerable progress has been made: the Federal Drug Administration (FDA) has approved drugs labelled on specific genomics biomarkers [ 40 ], tests for the long-term genetic-based management of breast cancer [ 41 ], emerging titration schemes tested for specific medication [ 42 ], and dispensing devices designed for diabetic or Parkinson’s Disease patient support [ 43 ]. Nowadays, e-skin sensors are designed and developed to measure and display physiological variables such as heart rate, blood oxygen saturation, glucose, or moisture.…”

Section: Introductionmentioning

confidence: 99%

Early Notice Pointer, an IoT-like Platform for Point-of-Care Feet and Body Balance Screening

et al. 2022

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Improper foot biomechanics associated with uneven bodyweight distribution contribute to impaired balance and fall risks. There is a need to complete the panel of commercially available devices for the self-measurement of BMI, fat, muscle, bone, weight, and hydration with one that measures weight-shifting at home as a pre-specialist assessment system. This paper reports the development of the Early Notice Pointer (ENP), a user-friendly screening device based on weighing scale technology. The ENP is designed to be used at home to provide a graphic indication and customised and evidence-based foot and posture triage. The device electronically detects and maps the bodyweight and distinct load distributions on the main areas of the feet: forefoot and rearfoot. The developed platform also presents features that assess the user’s balance, and the results are displayed as a simple numerical report and map. The technology supports data display on mobile phones and accommodates multiple measurements for monitoring. Therefore, the evaluation could be done at non-specialist and professional levels. The system has been tested to validate its accuracy, precision, and consistency. A parallel study to describe the frequency of arch types and metatarsal pressure in young adults (1034 healthy subjects) was conducted to explain the importance of self-monitoring at home for better prevention of foot arch- and posture-related conditions. The results showed the potential of the newly created platform as a screening device ready to be wirelessly connected with mobile phones and the internet for remote and personalised identification and monitoring of foot- and body balance-related conditions. The real-time interpretation of the reported physiological parameters opens new avenues toward IoT-like on-body monitoring of human physiological signals through easy-to-use devices on flexible substrates for specific versatility.

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The Importance of Individualized Vancomycin Dosing to Ensure Optimal Exposure Early in Therapy

Cited by 4 publications

References 17 publications

The Impact of Concomitant Empiric Cefepime on Patient Outcomes of Methicillin-Resistant Staphylococcus aureus Bloodstream Infections Treated With Vancomycin

The Impact of Concomitant Empiric Cefepime on Patient Outcomes of Methicillin-Resistant Staphylococcus aureus Bloodstream Infections Treated With Vancomycin

Genetic Algorithms as a Tool for Dosing Guideline Optimization: Application to Intermittent Infusion Dosing for Vancomycin in Adults

Early Notice Pointer, an IoT-like Platform for Point-of-Care Feet and Body Balance Screening

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