Vancomycin Use in Patients Requiring Hemodialysis: A Literature Review

Abstract

Vancomycin, a glycopeptide antibiotic, has remained a popular antimicrobial agent throughout the past five decades, and is often included in empiric antibiotic regimens. With gram-positive coverage, it has found a niche in the treatment of methicillin-resistant Staphylococcus aureus. Although vancomycin has been in existence for many years, questions remain regarding its use. New technologies and practice pattern changes have occurred over the years that altered vancomycin dosing in hemodialysis (HD) patients. Examples of these changes include increased resistance of many organisms, development of high flux HD filters, and reprocessing practices. This review provides a summary of the several concerns that exist in the dosing of vancomycin in HD patients today, and provides a summary table of intradialytic dosing regimens.

Staphylococcus aureus Infections in Hemodialysis

“…Whereas older preparations of vancomycin-also called Mississippi mud-suffered from frequent adverse effects such as nephrotoxicity, infusion-related toxicity, and ototoxicity, newer formulation are generally well tolerated (98). Vancomycin can be dosed intermittently on hemodialysis days, with trough levels being the most practical and accurate method to monitor effectiveness (98,99). A trough level of at least 10 and preferably 15 to 20 mg/L should be obtained to prevent the emergence of resistance during therapy and maximize the therapeutic response (98,99).…”

“…Vancomycin can be dosed intermittently on hemodialysis days, with trough levels being the most practical and accurate method to monitor effectiveness (98,99). A trough level of at least 10 and preferably 15 to 20 mg/L should be obtained to prevent the emergence of resistance during therapy and maximize the therapeutic response (98,99). Vancomycin is partially removed by most currently used hemodialysis filters (99).…”

Evaluation of the synergistic potential of vancomycin combined with other antimicrobial agents against methicillin-resistant Staphylococcus aureus and coagulase-negative Staphylococcus spp strains

“…The wide use of VAN for the treatment of severe infections caused by MRSA and MRCNS and its therapeutic failures have led to an increase in microbial resistance, relapse of infection incidence and worsening of patients' clinical conditions (Pallotta & Manley 2008, Rybak et al 2009, Dehority 2010, Hazlewood et al 2010). Due to a lack of therapeutic options, some studies have focused on the combination of two or more antibiotics as an alternative treatment (Totsuka et al 1999, Rochon-Edouard et al 2000, Kobayashi 2005, Yamaoka 2007, Nguyen & Graber 2010.…”

Vancomycin: The Tale of the Vanquisher and the Pyrrhic Victory

“…When vancomycin is given at each dialysis session, the levels follow a triphasic course (31,32). Administration at the end of dialysis is followed by a rapid redistribution phase.…”

“…Administration at the end of dialysis is followed by a rapid redistribution phase. Thereafter, levels decline steadily in the interdialytic interval, with a half-life of 100 -200 hours, depending on the degree of residual renal function (31,32). Finally, intradialytic clearance of vancomycin reduces vancomycin levels by 30% -46%.…”