Development and evaluation of vancomycin dosage guidelines designed to achieve new target concentrations

Thomson, A H; Staatz, C. E.; Tobin, C. M.; Gall, Mari-Anne; Lovering, A. M.

doi:10.1093/jac/dkp085

Cited by 123 publications

(142 citation statements)

References 44 publications

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“…Sanchez et al's model, 18 Thomson et al's model 23 and Mulla's model 26 did not show a good prediction in our data, and Bayesian forecasting was not performed. In Sanchez et al's study, 18 141 patients were used to build the population pharmacokinetic model, and external validation was conducted with data from 95 patients.…”

Section: Discussioncontrasting

confidence: 65%

Predictive performance of reported population pharmacokinetic models of vancomycin in Chinese adult patients

Deng

Liu

et al. 2013

J Clin Pharm Ther

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SUMMARYWhat is known and objective: There are numerous studies on population pharmacokinetics of vancomycin in adult patients. However, there is no such research for Chinese adult patients. This study was conducted to evaluate the predictive performance of reported population pharmacokinetic models of vancomycin in Chinese adult patients and to identify some models appropriate for our population. Methods: A literature search was conducted in PubMed to obtain the population pharmacokinetic models of vancomycin published between December 2010 and September 2012. The models were assessed using concentration data collected from Chinese patients for external validation. Models with relatively poor predictability were excluded from further analysis. The performance of the remaining models was evaluated in patients with different levels of creatinine clearance, age, body weight and sex by Bayesian method. This method was also used to compare the predictive performance based on peak concentration and trough concentration and the predictability based on different number of observed concentrations. Results: One hundred and sixty-five blood concentrations from 72 Chinese adult patients were collected retrospectively to serve as the test data set. The evaluated models included all those reported in the seven publications reviewed by Marsot et al. and three other studies published after December 2010. Three models with poor performance on external validation were excluded from the next Bayesian analysis. The distribution of covariates in the model building data set had an important effect on prediction. The predictability based on peak/trough concentration was similar among the evaluated models, and no significant difference was found using our data set except for Roberts' model. As expected, an increased number of samples improved the performance of the Bayesian prediction. What is new and conclusion: With our data set, the performance of the evaluated models varied. The characteristics of the patient population and distribution of covariates should be given more consideration when choosing a model to predict blood concentrations. The model developed by Purwonugroho et al. using a data set from patients similar to ours is appropriate for Bayesian dose predictions for vancomycin concentrations in our population of Chinese adult patients. WHAT IS KNOWN AND OBJECTIVEVancomycin is a glycopeptide antibiotic, with time-dependent bacterial killing effect, which is used for therapy of infections caused by penicillinase-producing Staphylococcus aureus, especially methicillin-resistant Staphylococcus aureus (MRSA), Staphylococcus epidermis and Enterococcus faecalis.

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Section: Discussioncontrasting

confidence: 65%

Predictive performance of reported population pharmacokinetic models of vancomycin in Chinese adult patients

Deng

Liu

et al. 2013

J Clin Pharm Ther

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“…In other studies, the authors focused on the AUC and especially the AUC/MIC ratio [17] , the target being 400 [3,18] . Our strategy led to an AUC being ∼ 350 μg/mL and the target AUC/MIC ratio was reached only in one patient out of 8.…”

Section: Discussionmentioning

confidence: 99%

Vancomycin during the Last Hour of the Hemodialysis Session: A Pharmacokinetic Analysis

Ghouti-terki

Chasseuil²,

Rabot

et al. 2017

Nephron

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Background: Vancomycin is usually administered after the dialysis sessions to patients undergoing hemodialysis. Administration of vancomycin during (as opposed to after) sessions would save time, and would be more acceptable to patients and staff, but may lead to vancomycin underexposure. The aim of this study was to propose a new dosing regimen of vancomycin taking into account the dialysis-related losses of vancomycin when administered during dialysis. Methods: In this monocentric prospective study, vancomycin was infused to dialyzed patients during the last hour of the dialysis session at increased doses. Monitoring of vancomycin was performed using repeated blood samples by pharmacokinetics modeling. Patients were treated according to our protocol and guidelines. Results: Twenty patients were included. Vancomycin protocol was efficient: 17 of 20 (85%) patients were cured, 1 needed additional vancomycin treatment, and 2 died (sepsis n = 1, multiple organ failure n = 1). Median pre-dialysis concentration was adequate (16.2 [10.2-24.4] µg/mL), and there was no emergence of resistant bacteria. Infusion of vancomycin during dialysis therefore decreased the exposure to vancomycin by 25% compared to infusion of vancomycin after dialysis. For a typical patient, the dose of vancomycin to be administered during dialysis would be 1.4 g. Conclusion: Administration of vancomycin during the last hour of dialysis session is safe, efficacious with regards to infection control, achieved recommended vancomycin concentrations despite the use of high-flux membranes, and improved patients' quality of life.

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“…Le nomogramme ne doit pas remplacer le jugement du clinicien chez les patients dont la fonction rénale est instable ou réduite. 4 Given that a correlation between creatinine clearance and vancomycin clearance has been clearly demonstrated, 5 dosage adjustments based on renal function are warranted.…”

Section: Discussionunclassified

“…8,13,14 Furthermore, several other studies have used creatinine clearance in the development of vancomycin dosing nomograms. 5,[10][11][12] As a more rigorous nomogram, an integrated nomogram was constructed and compared with the institution-specific nomograms. The validation results confirmed that the integrated nomogram could be applied at both sites.…”

Section: Discussionmentioning

confidence: 99%

Development and Validation of a Novel Vancomycin Dosing Nomogram for Achieving High-Target Trough Levels at 2 Canadian Teaching Hospitals

Thalakada¹,

Legal²,

Lau³

et al. 2012

CJHP

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Development and evaluation of vancomycin dosage guidelines designed to achieve new target concentrations

Abstract: New vancomycin dosage guidelines have been developed that achieve trough concentrations of 10-15 mg/L earlier and more consistently than current guidelines.

Cited by 123 publications

References 44 publications

Predictive performance of reported population pharmacokinetic models of vancomycin in Chinese adult patients

Predictive performance of reported population pharmacokinetic models of vancomycin in Chinese adult patients

Vancomycin during the Last Hour of the Hemodialysis Session: A Pharmacokinetic Analysis

Development and Validation of a Novel Vancomycin Dosing Nomogram for Achieving High-Target Trough Levels at 2 Canadian Teaching Hospitals

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