The pharmacokinetics of vancomycin in patients with severe acute pancreatitis

He, Juan; Mao, Enqiang; Feng, Jing; Jiang, Huiting; Yang, Weiping; Chen, Erzhen

doi:10.1007/s00228-016-2018-0

Cited by 10 publications

(10 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Vancomycin Ctroughs were significantly reduced in this subpopulation and, therefore, patients with severe acute pancreatitis need higher doses to ensure clinical effects …”

Section: Therapeutic Drug Monitoringmentioning

confidence: 97%

“… Severe acute pancreatitisVancomycin Ctroughs were significantly reduced in this subpopulation and, therefore, patients with severe acute pancreatitis need higher doses to ensure clinical effects Trauma patientsVancomycin pharmacokinetics in this subpopulation is best described by a two‐compartment open model; Clcr was related to Clvan (0.49 L/h) and decreases in the presence of furosemide (0.34 L/h).…”

Section: Therapeutic Drug Monitoringmentioning

confidence: 99%

See 1 more Smart Citation

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

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.

show abstract

“…Vancomycin Ctroughs were significantly reduced in this subpopulation and, therefore, patients with severe acute pancreatitis need higher doses to ensure clinical effects …”

Section: Therapeutic Drug Monitoringmentioning

confidence: 97%

Section: Therapeutic Drug Monitoringmentioning

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

“…Recently, augmented renal clearance (ARC) has been proposed to describe the enhancement of renal elimination of circulating solutes observed in critically ill patients [19]. Most studies have shown that hyperdynamic circulation is characterized by increased renal blood flow with an increase in glomerular filtration rate as a potential mechanism [20]. Nevertheless, no information was given concerning the number of oncological patients in these studies.…”

Section: Discussionmentioning

confidence: 99%

“…The vancomycin dosage was administered over a 1-hour period. The steady state vancomycin trough concentration was measured prior to subsequent treatment to adjust dose and dose intervals [8] . The target serum vancomycin trough concentrations ranged from 10-15 or 15-20 mg/L [9].Serum vancomycin concentrations were measured by FPIA method using a Cobas 6000 c501 analyzer (Roche Diagnostics, China).…”

Section: Pharmacokinetic Analysis and Vancomycin Therapeutic Drug Monmentioning

confidence: 99%

Therapeutic Drug Monitoring and Impact Indicator of Vancomycin Pharmacokinetics in Abdominal Cancer Patients complicated with Severe Infectious Disease

Zhang

Lyu

Wang

2019

Preprint

View full text Add to dashboard Cite

Objective: This study was designed to investigate effectiveness of therapeutic drug monitoring (TDM) and impact indicator of vancomycin pharmacokinetics in abdominal cancer patients complicated with severe infectious disease. Methods: A total of 78 patients abdominal cancer patients complicated with severe infectious disease were included. Vancomycin serum trough concentrations were measured using the fluorescence polarization immunoassay (FPIA) method. The patients were divided into early and delayed groups based on whether they achieve the target concentration. And clinical factors were compared between two groups. Results: The average initial therapeutic dose of vancomycin was 15.18±3.29 mg/kg (q12h). Ultimately, we collected 78 patient‘s trough concentrations data. The research revealed that the abdominal cancer patients complicated with severe infectious disease had significantly lower initial vancomycin trough concentrations (median [IQR]: 6.90[5.28-11.20] mg/L) compared with the recommended standard goal vancomycin trough concentration (10-15 or 15-20 mg/L). Multiple regression analysis revealed that Cys-C was the most important variable for vancomycin target trough achievement. We divided patients into early and delayed groups based on whether the initial trough concentration achieved standard goal trough concentration. Although the clinical outcomes were similar between two groups, the duration of mechanical ventilation in Early group was considerably shorter compared with group Delayed group (χ2=4.532; p < 0.05; Fig 1E). Propensity score weighting further confirmed that the duration of mechanical ventilation (χ2=6.607; p < 0.05; Fig 1F) and vasoactive agent (χ2=6.106; p < 0.05; Fig 1D) was considerably shorter compared with group Delayed group. Conclusions: The steady-state initial vancomycin trough concentration was significantly reduced in abdominal cancer patients complicated with severe infectious disease. Higher initial dosage regimen is needed to ensure clinical effectiveness. The baseline Cys-C level measured prior to administration of vancomycin is suggested to be the most suitable parameter to predict whether vancomycin trough concentration is up to standard dosage. Early attainment of target concentration significantly improved hemodynamic stability and reduced duration of mechanical ventilation.

show abstract

“…Vancomycin serum trough concentrations are correlated with a variety of factors, including renal function, which is one of the most commonly recognized 9,10 . Age, 9,11 blood level of albumin, 11 sepsis duration, 10 and the time from severe acute pancreatitis onset to vancomycin therapy 11 have also been identified as variables that influence vancomycin concentrations. However, the results of different studies are not consistent.…”

Section: What Is Known and Objectivementioning

confidence: 99%

An individualized administration model of vancomycin in elderly patients with sepsis and factors influencing augmented renal clearance

2020

View full text Add to dashboard Cite

What is known and objective Vancomycin efficacy is dependent on appropriate dosing, which should aim to achieve a target serum trough level. The purpose of this study was to determine the variables that predicted vancomycin serum trough concentrations in elderly patients with sepsis. Methods This retrospective cohort study, which was conducted in the medical ICU of a university‐affiliated teaching hospital in China, included 87 medical patients with sepsis who were enrolled from January 2014 to December 2017. Results and discussion All the patients were at least 60 years old (mean age = 74.8 ± 8.2 years), and 51.7% (n = 45) of them were male. The most common primary site of infection was the lungs (67.8%), followed by the abdomen (12.6%). Patients with septic shock accounted for 21.8% (n = 19) of the cases. The proportion of patients with vancomycin serum trough concentrations reaching target concentrations (≥15 mg/L) was 47.1% (41 cases). Multivariate linear regression showed that the creatinine clearance rate (CCR) and the daily dosage of vancomycin were independent predictors of vancomycin serum trough concentrations (both p's < 0.05), and the model for predicting vancomycin trough concentrations should be: serum trough concentration (mg/L) = 15.942 − 0.101 × CCR (mL/min) + 0.347 × vancomycin daily doses (mg/kg/d). Augmented renal clearance (ARC) was present in 13 patients (14.9%), and logistic regression revealed body mass index (OR = 1.420, p = .002) and serum creatinine level (OR = 0.883, p = .002) were independent predictors of ARC. What is new and conclusion The CCR and daily dosage of vancomycin were significantly correlated with vancomycin serum trough concentrations in elderly patients with sepsis, and the individualized administration model should be verified through further clinical trials. BMI and serum creatinine level were identified to be independent predictors of ARC in elderly patients.

show abstract

The pharmacokinetics of vancomycin in patients with severe acute pancreatitis

Abstract: The serum trough concentration of vancomycin was significantly reduced in SAP patients. Higher dosage regimens are needed to ensure the clinical effect.

Cited by 10 publications

References 22 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

Therapeutic Drug Monitoring and Impact Indicator of Vancomycin Pharmacokinetics in Abdominal Cancer Patients complicated with Severe Infectious Disease

An individualized administration model of vancomycin in elderly patients with sepsis and factors influencing augmented renal clearance

Contact Info

Product

Resources

About