Daily vancomycin dose requirements as a continuous infusion in obese versus non-obese SICU patients

Lin, Hsin; Yeh, D. Dante; Levine, Alexander

doi:10.1186/s13054-016-1363-9

Cited by 13 publications

(29 citation statements)

References 19 publications

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“…Similarly, patients in the middle-old or old-old subset who are obese may also need altered dosing regimens [69, 70]. In these patients, loading doses of 15–25 mg/kg should be based on actual body weight [71].…”

Section: Practical Applicationsmentioning

confidence: 99%

“…In these patients, loading doses of 15–25 mg/kg should be based on actual body weight [71]. Because vancomycin accumulates in the tissues [58, 72], consideration should be given to empirically reducing the maintenance dose, particularly in patients who are critically ill [9, 29, 68, 70]. Additionally, even though vancomycin is 50% bound to serum albumin [10], clinically dosing vancomycin according to serum albumin concentrations is not performed.…”

Section: Practical Applicationsmentioning

confidence: 99%

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Intravenous Vancomycin Dosing in the Elderly: A Focus on Clinical Issues and Practical Application

et al. 2016

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The elderly population can be divided into three distinct age groups: 65–74 years (young-old), 75–84 years (middle-old), and 85+ years (old-old). Despite evidence of a shift in leading causes for mortality in the elderly from infectious diseases to chronic conditions, infections are still a serious cause of death in this population. These patients are at increased risk due to weakened immune systems, an increased prevalence of underlying comorbidities, and decreased physiologic reserves to fight infection. Additionally, elderly patients, especially adults in institutional settings, are at an increased risk of colonization and subsequent infection with methicillin-resistant Staphylococcus aureus at a rate that is five times higher than in younger individuals, causing an increase in empiric and definitive vancomycin use. Elderly patients have unique characteristics that make dosing vancomycin a challenge for clinicians, such as increased volume of distribution and decreased renal function. Using the best available evidence, it is recommended to initiate lower empiric maintenance doses and monitor vancomycin serum concentrations earlier than steady state to accurately calculate drug elimination and make appropriate dose adjustments.

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Section: Practical Applicationsmentioning

confidence: 99%

Section: Practical Applicationsmentioning

confidence: 99%

Intravenous Vancomycin Dosing in the Elderly: A Focus on Clinical Issues and Practical Application

et al. 2016

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“…The majority of the studies (16/21) was performed in Europe, 33, 46, 47, 58, 59, 61–63, 67, 68, 70, 71, 73, 75, 85, 87 three in North America, 56, 57, 64 one in South America, 86 one in Australia. 72 The studies were conducted between 2001 and 2020.…”

Section: Resultsmentioning

confidence: 99%

Serum Concentration of Continuously administered Vancomycin influences Efficacy and Safety in Critically Ill Adults: A Systematic Review

Viertel

Feles

Schulte

et al. 2022

Preprint

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BackgroundVancomycin is an antibiotic to empirically treat gram-positive infections in critically ill adults in the intensive care unit (ICU). For continuously administered vancomycin (CI), various target ranges have been used in the past, ranging from 15-20 mg/L to 30-40 mg/L.ObjectivesTo investigate the impact of steady-state serum concentration (Css) of CI on the safety and efficacy of therapy in adults in the intensive care unit: a systematic literature review.MethodsAccording to the PRISMA statement, relevant literature was identified by searching three electronic databases (MEDLINE through the PubMed interface, Cochrane Library and Google Scholar) from inception until March 2022, focussing on studies reporting measured steady-state serum concentration of vancomycin (Css) and treatment outcomes (mortality, nephrotoxicity) with CI. Due to the heterogeneity of the study designs and outcome measures, it was not possible to summarise the results in a meta-analysis. Therefore, a narrative synthesis of the evidence was performed.ResultsTwenty-one publications were included with a total of 2,949 patients (pts) with CI. In two studies (n=388 pts) mortality rates were reported and cohorts with different Css compared. Mortality was higher with a Css <15 mg/L measured approximately 24 hours after initiation of therapy with CI (C24). An adequate loading dose appeared most important for maintaining higher C24. Acute kidney injury (AKI) in cohorts with different Css was described in four studies (n=863 pts). In one study (n=129 pts), a mean Css throughout the duration of therapy (Cmean) of >30 mg/L was found to predict AKI. No clear cutoff value for Css has been identified in the other studies, but higher concentrations led to higher rates of AKI. We calculated that a Css <25 mg/L was preferable compared to a concentration ≥25 mg/L for reducing nephrotoxicity. Data on target attainment and Css was mentioned in eleven studies (n=1,391 pts). We noticed higher target attainment rates in the studies if the defined target ranges were lower and broader. No association between target attainment and effectiveness (e.g. mortality) of therapy with CI has been observed so far. In two studies (n=101 pts) data on clinical response was presented and compared in cohorts with different Css of which in one study (n=40 pts) higher clinical cure was detected with a C24 >15 mg/L while in the other study (n=61 pts), treatment success was reported at higher Cmean, with sparing out a clear cutoff calculation.ConclusionDespite sparse data availability, it seems that for continuous infusion of vancomycin the mortality was increased if C24 was <15 mg/L, AKI may be reduced if Cmean was <25 mg/L, clinical cure was more likely to occur at C24 >15 mg/L, while no relationship between target attainment and efficacy has yet been established. In future research, vancomycin serum concentration cohorts should be formed to allow evaluation of the impact of serum concentration of CI on treatment outcomes.

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“…(19) Caution has been suggested when using continuous vanco infusions in obese patients, as lower maintenance doses seem to be necessary. (20) …”

Section: Discussionmentioning

confidence: 99%

Currently used dosage regimens of vancomycin fail to achieve therapeutic levels in approximately 40% of intensive care unit patients

Obara¹,

Zacas²,

Carrilho³

et al. 2016

Revista Brasileira De Terapia Intensiva

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ObjectiveThis study aimed to assess whether currently used dosages of vancomycin for treatment of serious gram-positive bacterial infections in intensive care unit patients provided initial therapeutic vancomycin trough levels and to examine possible factors associated with the presence of adequate initial vancomycin trough levels in these patients.MethodsA prospective descriptive study with convenience sampling was performed. Nursing note and medical record data were collected from September 2013 to July 2014 for patients who met inclusion criteria. Eighty-three patients were included. Initial vancomycin trough levels were obtained immediately before vancomycin fourth dose. Acute kidney injury was defined as an increase of at least 0.3mg/dL in serum creatinine within 48 hours.ResultsConsidering vancomycin trough levels recommended for serious gram-positive infection treatment (15 - 20µg/mL), patients were categorized as presenting with low, adequate, and high vancomycin trough levels (35 [42.2%], 18 [21.7%], and 30 [36.1%] patients, respectively). Acute kidney injury patients had significantly greater vancomycin trough levels (p = 0.0055, with significance for a trend, p = 0.0023).ConclusionSurprisingly, more than 40% of the patients did not reach an effective initial vancomycin trough level. Studies on pharmacokinetic and dosage regimens of vancomycin in intensive care unit patients are necessary to circumvent this high proportion of failures to obtain adequate initial vancomycin trough levels. Vancomycin use without trough serum level monitoring in critically ill patients should be discouraged.

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Daily vancomycin dose requirements as a continuous infusion in obese versus non-obese SICU patients

Cited by 13 publications

References 19 publications

Intravenous Vancomycin Dosing in the Elderly: A Focus on Clinical Issues and Practical Application

Intravenous Vancomycin Dosing in the Elderly: A Focus on Clinical Issues and Practical Application

Serum Concentration of Continuously administered Vancomycin influences Efficacy and Safety in Critically Ill Adults: A Systematic Review

Currently used dosage regimens of vancomycin fail to achieve therapeutic levels in approximately 40% of intensive care unit patients

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