Comparison of 3 vancomycin dosage regimens during hemodialysis with cellulose triacetate dialyzers: post-dialysis versus intradialytic administration

Mason, Nancy A.; Neudeck, Brien L.; Welage, Lynda S.; Patel, Jeet; Swartz, R. D.

doi:10.5414/cnp60096

Cited by 35 publications

(42 citation statements)

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“…However, the models of both Vandecasteele and others 6 and Zelenitsky and others 27 were based on administration of vancomycin during the last 60 min of hemodialysis, whereas the model in the current study was based on administration of vancomycin after completion of the hemodialysis session. Moreover, Mason and others 28 found that administering vancomycin 30 mg/kg in the last 1-2 h of hemodialysis achieved a similar pre-hemodialysis concentration as administering a vancomycin dose of 15 mg/kg after completion of the hemodialysis session. Similarly, Lucksiri and others 15 detected that 24% of vancomycin was removed if the dose was administered during the last hour of dialysis, whereas none of the dose was lost if it was administered after completion of the session.…”

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confidence: 85%

Predicting Maintenance Doses of Vancomycin for Hospitalized Patients Undergoing Hemodialysis

Nekidy

El-Masri

Umstead

et al. 2016

CJHP

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Background: Methicillin-resistant Staphylococcus aureus is a leading cause of death in patients undergoing hemodialysis. However, controversy exists about the optimal dose of vancomycin that will yield the recommended pre-hemodialysis serum concentration of 15-20 mg/L. Objective: To develop a data-driven model to optimize the accuracy of maintenance dosing of vancomycin for patients undergoing hemodialysis. Methods: A prospective observational cohort study was performed with 164 observations obtained from a convenience sample of 63 patients undergoing hemodialysis. All vancomycin doses were given on the floor after completion of a hemodialysis session. Multivariate linear generalized estimating equation analysis was used to examine independent predictors of pre-hemodialysis serum vancomycin concentration. Results: Pre-hemodialysis serum vancomycin concentration was independently associated with maintenance dose (B = 0.658, p < 0.001), baseline pre-hemodialysis serum concentration of the drug (B = 0.492, p < 0.001), and interdialytic interval (B = -2.133, p < 0.001). According to the best of 4 models that were developed, the maintenance dose of vancomycin required to achieve a pre-hemodialysis serum concentration of 15-20 mg/L, if the baseline serum concentration of the drug was also 15-20 mg/L, was 5.9 mg/kg with interdialytic interval of 48 h and 7.1 mg/kg with interdialytic interval of 72 h. However, if the baseline pre-hemodialysis serum concentration was 10-14.99 mg/L, the required dose increased to 9.2 mg/kg with an interdialytic interval of 48 h and 10.0 mg/kg with an interdialytic interval of 72 h. Conclusions: The maintenance dose of vancomycin varied according to baseline pre-hemodialysis serum concentration of the drug and interdialytic interval. The current practice of targeting a pre-hemodialysis concentration of 15-20 mg/L may be difficult to achieve for the majority of patients undergoing hemodialysis.

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confidence: 85%

Predicting Maintenance Doses of Vancomycin for Hospitalized Patients Undergoing Hemodialysis

Nekidy

El-Masri

Umstead

et al. 2016

CJHP

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“…Vancomycin, another antibiotic used for Gram-positive bacterial infections, was originally infused after HD ended, causing a similar disruption to the HD treatment schedule. Studies by our group (3) and others (4)(5)(6) found that infusion of vancomycin during the final 60 to 90 min of HD can achieve therapeutic serum concentrations while alleviating the delay caused by infusions extending beyond the HD session. Intradialytic vancomycin is now the standard treatment at most HD centers, although larger vancomycin dosages must be administered to compensate for the intradialytic drug removal.…”

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confidence: 99%

Intradialytic Administration of Daptomycin in End Stage Renal Disease Patients on Hemodialysis

Salama

Segal

Churchwell

et al. 2009

Clinical Journal of the American Society of Nephrology

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“…When the collection times are considered, one can infer that the number of patients reaching trough concentrations below 5 µg/mL would be greater. It is also worth noting that vancomycin has been administered during the HD session, but supplementary doses are not administered according to the recommendation of Mason et al (2003) who have compared three regimens of vancomycin dosing. 7 In conclusion, the patients included in this study were exposed to antibiotic subtherapeutic doses.…”

Section: Discussionmentioning

confidence: 99%

“…It is also worth noting that vancomycin has been administered during the HD session, but supplementary doses are not administered according to the recommendation of Mason et al (2003) who have compared three regimens of vancomycin dosing. 7 In conclusion, the patients included in this study were exposed to antibiotic subtherapeutic doses. Considering the increased risk of selecting resistant microorganisms, monitoring of vancomycin serum concentration in HD patients is recommended.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, vancomycin has a long half life in renal failure, which allows using intermittent doses regimes. 7 However, the pharmacokinetic characteristics of this antibiotic should be respected to maintain adequate levels, minimize the appearance of resistant strains, and avoid toxicity. 8 Changes in renal function associated with normal aging or with diseases can have a deep effect on the pharmacology of antibiotics, which require their doses to be adjusted.…”

Section: Introductionmentioning

confidence: 99%

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Vancomycin: the need to suit serum concentrations in hemodialysis patients

Marengo¹,

Fiol²,

Oliveira³

et al. 2010

Braz J Infect Dis

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The vancomycin dose for hemodialysis (HD) patients should be adjusted by monitoring drug serum concentrations. However, this procedure is not available in most health services in Brazil, which usually adopts protocols based on published studies. The trials available are controversial, and several have not been conducted with current dialyzers. This study aimed at assessing the suitability of vancomycin serum concentrations in HD patients at a public hospital. Blood samples of HD patients were collected from November 2006 to May 2007, at time intervals of 48, 96, 120, or 168 hours after vancomycin administration. Drug measurement was performed with polarized light immunofl uorescence. Approximately 86% of trough vancomycin serum concentrations were below the recommended value, indicating exposure to subtherapeutic doses and a higher risk for selecting resistant microorganisms.

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Comparison of 3 vancomycin dosage regimens during hemodialysis with cellulose triacetate dialyzers: post-dialysis versus intradialytic administration

Cited by 35 publications

References 0 publications

Predicting Maintenance Doses of Vancomycin for Hospitalized Patients Undergoing Hemodialysis

Predicting Maintenance Doses of Vancomycin for Hospitalized Patients Undergoing Hemodialysis

Intradialytic Administration of Daptomycin in End Stage Renal Disease Patients on Hemodialysis

Vancomycin: the need to suit serum concentrations in hemodialysis patients

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