Therapeutic drug monitoring of vancomycin: a guideline of the Division of Therapeutic Drug Monitoring, Chinese Pharmacological Society

Ye, Zhikang; Chen, Yaolong; Chen, Ken; Zhang, Xianglin; Du, Guanhua; He, Ben; Li, Dakui; Liu, You-ning; Yang, Kehu; Zhang, Yingyuan; Zhai, Suodi

doi:10.1093/jac/dkw254

Cited by 98 publications

(96 citation statements)

References 14 publications

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“…The methodology followed was similar to that used by Ye and coworkers . Three guidelines were selected as the basis of this work: the American from 2009 (AME), the Japanese from 2013 (JPN) and the Chinese from 2016 (CHN) guidelines on vancomycin TDM. These guidelines were analyzed, compared, and recomendations were evaluated.…”

Section: Methodsmentioning

confidence: 99%

“…Level of evidence (LoE) and grade of recommendation (GoR) used in this work are shown in Table . The LoE and GoR used are in agreement with the GRADE system, also used in the CHN guideline . For comparison purposes, the graduation scale used in AME and JPN guidelines were transformed by two researchers, independently, and then discussed for consensus.…”

Section: Methodsmentioning

confidence: 99%

“…the American from 2009 (AME), 2 the Japanese from 2013 (JPN) 3 and the Chinese from 2016 (CHN) 4 guidelines on vancomycin TDM.…”

Section: Me Th Odologymentioning

confidence: 99%

“…Authors could not find additional data on the clinical relevance of TDM, other than that described by the CHN guideline. 4 However, a meta-analysis, including one randomized controlled trial (RCT) and five cohort studies, showed that TDM significantly increases the rate of clinical efficacy and decreases the rate of nephrotoxicity in patients treated with vancomycin. 6 More recently, another RCT, comparing groups of patients treated with vancomycin (simple infections or infections with MRSA), with and without TDM also confirmed this conclusion.…”

Section: Indication and Relevancementioning

confidence: 99%

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Vancomycin therapeutic drug monitoring and population pharmacokinetic models in special patient subpopulations

Monteiro

Hahn

Gonçalves

et al. 2018

Pharmacology Res & Perspec

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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.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

“…the American from 2009 (AME), 2 the Japanese from 2013 (JPN) 3 and the Chinese from 2016 (CHN) 4 guidelines on vancomycin TDM.…”

Section: Me Th Odologymentioning

confidence: 99%

Section: Indication and Relevancementioning

confidence: 99%

See 2 more Smart Citations

Vancomycin therapeutic drug monitoring and population pharmacokinetic models in special patient subpopulations

Monteiro

Hahn

Gonçalves

et al. 2018

Pharmacology Res & Perspec

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show abstract

“…Methicillin-resistant Staphylococcus aureus (MRSA) has gained considerable attention due to its high morbidity, limited effective treatments available and increased incidence [1]. Vancomycin has been recommended as the first line treatment for MRSA infections by American, European, and Chinese guidelines for infectious diseases control and management control for antibiotics [2][3][4][5]. However, the significant nephrotoxicity limits the use of vancomycin in daily clinical practice.…”

Section: Introductionmentioning

confidence: 99%

Vancomycin-associated acute kidney injury in Hong Kong in 2012–2016

et al. 2020

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Background:To study the incidence of vancomycin-associated acute kidney injury (VA-AKI) in Hong Kong and identify risk factors for VA-AKI. Method: Patients with vancomycin prescription and blood level measurement in 2012-2016 were identified using the Hong Kong Hospital Authority Clinical Data Analysis and Reporting System. Acute kidney injury was defined using KDIGO criteria. Patients without creatinine measurements, steady-state trough vancomycin level or who had vancomycin treatment < 3 days were excluded. Results were analyzed using SPSS version 22.0. Logistic regression was used to identify the predictors for VA-AKI. Odds ratio and 95% confidence interval were estimated. Results: One thousand four hundred fifty patients were identified as VA-AKI from 12,758 records in Hong Kong in 2012-2016. The incidence was respectively 10.6, 10.9, 11.3, 12.2, 11.2% from 2012 to 2016. The incidence of VA-AKI was 16.3, 12.2, 11.3 and 6.2% in patients aged 1-12, 12-60, elderly aged > 60 and newborn and infants, respectively. Baseline creatinine, serum trough vancomycin level, systematic disease history including respiratory failure, hypertension, congestive heart failure, chronic renal failure, anemia and type II diabetes, and concomitant diuretics, piperacillin-tazobactam (PTZ) and meropenem prescription were significantly higher in VA-AKI patients older than 12 years. Logistic regression showed that older age group, higher baseline creatinine, serum trough vancomycin level, respiratory failure, chronic renal failure and congestive heart failure, concomitant diuretics, PTZ and meropenem prescription, and longer hospital stay were all associated with increased risk of VA-AKI. Conclusion: The incidence of VA-AKI in Hong Kong is low but shows no decline. Patients with higher baseline creatinine, multi-organ diseases and multiple drugs administration should have their vancomycin level monitored to decrease the risk of VA-AKI.

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Clinical application of vancomycin population pharmacokinetics model in patients with hematological diseases and neutropenia

Lin

Huang

et al. 2021

Biopharm & Drug Disp

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To explore the clinical application of a population pharmacokinetics (PPK) model of vancomycin in patients with hematological diseases and neutropenia. Patients with hematological diseases and neutropenia were included in the PPK model study.Nonlinear mixed effect modeling approach (NONMEM) was used for model establishment. Monte Carlo simulation was carried out. A total of 74 patients were divided into model group and non-model group for clinical application research. The model group was given the initial dose of 1g q8h, and the non-model group was given 1g q12h as an empiric initial dosage. The follow-up dose adjustments were made according to the concentration results. This two-compartment model showed good stability and accuracy. The first trough concentration (C 0 ) and the compliance rate of the first C 0 were much higher in the model group than that in the non-model group (14.30 � 4.73 μg/ml and 59.38% vs. 8.02 � 2.61 μg/ml, 35.71%). Less patients needed dose adjustments and fewer adjustment times in the model group than those in the non-model group (12.50% and 0.13 � 0.34 times vs. 50.00% and 0.61 � 0.66 times). This suggested that for those patients who had a Creatinine clearance rate (CLCR) ≥ 90 ml/min/1.73 m 2 , the initial dose of 1g q8h may help to reach the target C 0 (10∼20 μg/ml) quickly. It also helped to reduce the times and number of patients who need dose adjustments. Our PPK model of vancomycin in patients with hematologic diseases and neutropenia can be used to shorten the time to reach the target concentration and reduce the number of dose adjustments.Clinical trial registration: Not applicable (Retrospective study).

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Therapeutic drug monitoring of vancomycin: a guideline of the Division of Therapeutic Drug Monitoring, Chinese Pharmacological Society

Abstract: We developed an evidence-based guideline for vancomycin TDM, which provides recommendations for clinicians and pharmacists to conduct vancomycin TDM in China.

Cited by 98 publications

References 14 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

Vancomycin-associated acute kidney injury in Hong Kong in 2012–2016

Clinical application of vancomycin population pharmacokinetics model in patients with hematological diseases and neutropenia

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