Vancomycin dosing nomograms targeting high serum trough levels in different populations: pros and cons

Elyasi, Sepideh; Khalili, Hossein

doi:10.1007/s00228-016-2063-8

Cited by 29 publications

(29 citation statements)

References 44 publications

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“…However, as seen in our study and with other vancomycin nomograms targeting higher trough concentrations, risk of supratherapeutic trough concentrations are increased. 29 It appears that with even the best performing nomograms, a tolerance of 10% to 25% of patients having slightly elevated initial trough concentrations may be necessary to minimize the risk of subtherapeutic treatment to <10% of patients. 29 In our study, kidney injury appeared reversible in all cases, suggesting that vancomycin maintains a favorable safety profile with either strategy in neonates in the NICU when used for short durations or when properly adjusted based on initial therapeutic drug monitoring.…”

Section: Discussionmentioning

confidence: 99%

The Effectiveness of a Vancomycin Dosing Guideline in the Neonatal Intensive Care Unit for Achieving Goal Therapeutic Trough Concentrations

Reilly

Ding

Rower

et al. 2019

The Journal of Clinical Pharma

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Concern for bacterial resistance and treatment failure with vancomycin trough concentrations < 10 μg/mL have led guidelines to increase goal concentrations. There is a paucity of data evaluating vancomycin dosage necessary to achieve goals in the neonatal intensive care unit (NICU). We aimed to evaluate the implementation of a new vancomycin dosing guideline in improving trough target attainment. This retrospective study evaluated neonates in the NICU treated with vancomycin between January 2009 and December 2015. Therapeutic trough concentration attainment (10-20 μg/mL) was compared between neonates receiving vancomycin per old versus new dosing guidelines. Vancomycin trough concentrations, modeled pharmacodynamic target attainment, and nephrotoxicity were compared between groups. A total of 212 vancomycin trough concentrations (n = 91 old and n = 121 new guideline) were evaluated in 182 unique neonates. The mean ± standard deviation trough concentration achieved was 18.0 ± 7.3 μg/mL vs 8.9 ± 4.8 μg/mL in the new and old guidelines, respectively (P < .01). The new guideline resulted in a higher percentage of neonates achieving trough concentrations of 10 to 20 μg/mL (62% vs 29%; P < .01) and decreased the percentage of neonates with subtherapeutic trough concentrations (9% vs 69%; P < .01). Pharmacokinetic modeling identified postmenstrual age, days of life, and urine output as predictors of vancomycin clearance and resultant trough and area under the curve values (P < .01 for all). Trough concentrations >10 μg/mL ensured area under the curve /minimum inhibitory concentration >400 in >90% of neonates when bacteria minimum inhibitory concentration was ࣘ 1 μg/mL. Nephrotoxicity was similar between groups (8.3% vs 7.7%; P = .99). In conclusion, a vancomycin nomogram designed to achieve trough concentration of 10 to 20 μg/mL improves pharmacodynamic target attainment in neonates in the NICU.

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Section: Discussionmentioning

confidence: 99%

The Effectiveness of a Vancomycin Dosing Guideline in the Neonatal Intensive Care Unit for Achieving Goal Therapeutic Trough Concentrations

Reilly

Ding

Rower

et al. 2019

The Journal of Clinical Pharma

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“…In total, it seems that using a vancomycin dosing nomogram in conditions which high-flux membranes are used or in old patients who were planned to use low-flux membranes, can significantly improve and accelerate the achievement of the target trough concentrations (14). As a rule, vancomycin is not significantly dialyzable when hemodialysis is performed using a low flux membrane, while vancomycin is dialyzable when hemodialysis is performed using a high flux membrane (15).…”

Section: Discussionmentioning

confidence: 99%

Vancomycin dosing in low-flux hemodialysis; is adjustment of drug dosage necessary?

Khodabandehloo¹,

Fourodi²,

Jenabi³

2018

J Renal Inj Prev

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Introduction: Vancomycin is a wide useable antibiotic against gram-positive bacteria species in different clinical setting particularly in hemodialysis patients. Objectives: The present study aimed to assess the serum level of vancomycin before and after hemodialysis. Patients and Methods: This cross-sectional study was performed on patients who were hospitalized and medicated by vancomycin with the loading dose of 1000 mg followed by the maintenance dose of 500 mg after each dialysis session every other day. All patients were dialyzed with a low-flux dialyzer membrane. Half an hour before and immediately after dialysis, 2 mL blood sample was taken and stored at -20°C until assaying the level of vancomycin. Results: The average reduction in the serum level of vancomycin was totally 17.65 ± 1.69%. The mean reduction in the serum level of vancomycin was significantly higher in the patients aged higher than 60 years, as compared to other ones. But the level of drug was independent to gender or body mass index. Conclusion: Using low-flux dialyzer membranes, the average reduction in the serum level of vancomycin is expected to be in the range of 12.43% to 21.56% that age was directly associated with the average reduction of the level of vancomycin. Therefore, adjusting and monitoring the serum level of drug in old ages even in the cases of using low-flux dialyzer membranes is recommended.

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“…When level is high, especially above 30 mg/L, the adjustment is in the opposite direction . Patients with a level above 20 mg/L should be monitored for kidney function …”

Section: Vancomycinmentioning

confidence: 99%

Vancomycin dosing, monitoring and toxicity: Critical review of the clinical practice

Zamoner

Prado

Balbi

et al. 2019

Clin Exp Pharma Physio

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Summary Vancomycin is an antibiotic used in the treatment of infections caused by multidrug‐resistant Gram‐positive bacteria, especially methicillin‐resistant Staphylococcus aureus. In the last decades, vancomycin has been widely used in hospital environments due to the increasing incidence of sepsis and septic shock. Sepsis may lead to multiple organ failure; it is considered a risk factor for the development of acute kidney injury (AKI), with an overall mortality rate of around 45%, which can reach the surprising rate of 70% with the combination of AKI and sepsis. Considering the high mortality rate of sepsis and its related costs of hospitalization and treatment, specific measures should be adopted, such as early‐goal treatment protocols: proper and early administration of antimicrobials, fluids, vasoactive drugs and transfusion support. Besides the careful selection of the antimicrobial, another concern related to critically ill patients is the proper dose of the antimicrobial, since pharmacokinetic changes are observed due to drug absorption, distribution, metabolism and elimination. Gram‐positive pathogens are very common in hospitalized patients with septic shock, so vancomycin has been the antimicrobial of choice for more than 60 years. However, discussions about its dosage, administration and monitoring are extremely important, considering the risk of nephrotoxicity and the emergence of resistant S. aureus. This narrative review aims to discuss controversial aspects related to the efficacy and safety of vancomycin, correlating them with data available in the literature and identifying knowledge gaps in guide future lines of research.

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Vancomycin dosing nomograms targeting high serum trough levels in different populations: pros and cons

Cited by 29 publications

References 44 publications

The Effectiveness of a Vancomycin Dosing Guideline in the Neonatal Intensive Care Unit for Achieving Goal Therapeutic Trough Concentrations

The Effectiveness of a Vancomycin Dosing Guideline in the Neonatal Intensive Care Unit for Achieving Goal Therapeutic Trough Concentrations

Vancomycin dosing in low-flux hemodialysis; is adjustment of drug dosage necessary?

Vancomycin dosing, monitoring and toxicity: Critical review of the clinical practice

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