Evaluation of vancomycin pharmacokinetics in patients with augmented renal clearances: A randomized clinical trial

Sahraei, Zahra; Saffaei, Ali; Darazam, Ilad Alavi; Salamzadeh, Jamshid; Shabani, Minoosh; Shokouhi, Shervin; Sarvmeili, Najmeh; Hajiesmaeili, Mohammadreza; Zangi, Masood

doi:10.3389/fphar.2022.1041152

Cited by 3 publications

(6 citation statements)

References 31 publications

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“…Most of the included articles were observational studies, with 14 being retrospective and 5 prospective. One article [7] reported a combination of retrospective and prospective studies and the remaining article [12] was a randomized clinical trial. The studies included diverse ICU populations, including medical, surgical, neurosurgical, haemorrhagic Most of the included articles were observational studies, with 14 being retrospective and 5 prospective.…”

Section: Study Selectionmentioning

confidence: 99%

“…The studies included diverse ICU populations, including medical, surgical, neurosurgical, haemorrhagic Most of the included articles were observational studies, with 14 being retrospective and 5 prospective. One article [7] reported a combination of retrospective and prospective studies and the remaining article [12] was a randomized clinical trial. The studies included diverse ICU populations, including medical, surgical, neurosurgical, haemorrhagic stroke, traumatic brain injury (TBI), and septic patients, conducted in seven countries.…”

Section: Study Selectionmentioning

confidence: 99%

“…The main finding was decreased therapeutic concentrations following the increase in CrCl. When targeting a C trough of 10-20 mg/L, the reviewed articles revealed that a significant proportion of patients with a CrCl ≥ 130 mL/min (ranging from 34-100%) experienced subtherapeutic trough vancomycin concentrations (C trough < 10 mg/L) with standard vancomycin doses [7,8,10,12,18,20,[22][23][24][25][26]31]. In a prospective study conducted by Campassi et al that included 363 critically ill patients, ARC was assessed for its impact on serum vancomycin concentrations.…”

Section: Impact Of Arc On Vancomycin Therapymentioning

confidence: 99%

“…Moreover, patients with ARC exhibited a lower trend compared to the non-ARC group (232.9 vs. 316 mg.h/L) [24] (Table 1). In a randomized clinical trial conducted by Sahrai et al, two different regimens of vancomycin administration (15 mg/kg every 12 h or 8 h) were compared in ARC patients, revealing that target AUC/MIC was achieved by a higher percentage of the group receiving vancomycin every eight hours compared to every 12 h (82.14% versus 46.42%) [12]. The reviewed studies collectively suggested that the typical dosage was insufficient and that increased dosing or dosing frequency is required to achieve adequate concentration; however, only a few studies provided specific dosing recommendations [12,24,30] (Table 2).…”

Section: Impact Of Arc On Vancomycin Therapymentioning

confidence: 99%

“…Antibiotics like vancomycin depend on the magnitude of exposure over time for their antibacterial efficacy [9]. Recent studies have revealed that patients with ARC tend to have lower concentrations of vancomycin and require higher dosages to achieve optimal exposure [10][11][12].…”

Section: Introductionmentioning

confidence: 99%

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The Impact of Augmented Renal Clearance on Vancomycin Pharmacokinetics and Pharmacodynamics in Critically Ill Patients

Tesfamariam,

Aboelezz,

Mahmoud

2024

JCM

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Augmented renal clearance (ARC), defined as a creatinine clearance (CrCl) > 130 mL/min/1.73 m2, is observed in 30–65% of critically ill patients. When following standard dosage guidelines, patients with ARC often experience subtherapeutic vancomycin levels, resulting in treatment failure due to accelerated drug elimination. This review aims to explore ARC’s impact on vancomycin pharmacokinetics and pharmacodynamics (PK/PD) indices in ARC patients, seeking to identify an accurate dose adjustment method for this patient population. In September 2023, a comprehensive literature search was conducted on the MEDLINE and EMBASE databases to include all available studies providing information on the impact of ARC on vancomycin therapy in critically ill adults. Articles that studied the pediatric population and those with insufficient PK data were excluded. A total of 21 articles met the inclusion criteria. The findings revealed a positive correlation between CrCl and vancomycin clearance, indicating low serum concentrations. Therefore, upward dosing adjustments are necessary to improve treatment success. Younger age consistently emerged as a major contributor to ARC and vancomycin PK/PD alterations. This study summarizes the PK/PD alterations, current dosage recommendations and proposes preliminary recommendations on possible dosing approaches to decrease the risk of subtherapeutic exposure in this patient population.

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Section: Study Selectionmentioning

confidence: 99%

Section: Study Selectionmentioning

confidence: 99%

Section: Impact Of Arc On Vancomycin Therapymentioning

confidence: 99%

Section: Impact Of Arc On Vancomycin Therapymentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The Impact of Augmented Renal Clearance on Vancomycin Pharmacokinetics and Pharmacodynamics in Critically Ill Patients

Tesfamariam,

Aboelezz,

Mahmoud

2024

JCM

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Optimize Vancomycin Dose in Surgical Ward Patients with Augmented Renal Clearance Determined by Chronic Kidney Disease Epidemiology Collaboration Equation

Chen,

Wang,

Lin

et al. 2024

IDR

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Background In the field of postoperative care, infections caused by Gram-positive bacteria pose a major clinical challenge. Vancomycin is a key therapeutic agent whose efficacy is greatly influenced by renal function, particularly by augmented renal clearance (ARC). The Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) estimated glomerular filtration rate (eGFR) is an easy and commonly used method to predict ARC; however, it is not well studied to determine vancomycin dose. In this study, we examined the effectiveness of the CKD-EPI equation in determining ARC and optimizing the dose of vancomycin for surgical ward patients. Methodology A retrospective observational study was conducted to examine 158 surgical ward patients receiving vancomycin. Data on demographics, medical history, and vancomycin dosing were collected. Renal function was evaluated using the CKD-EPI equation, with ARC defined as eGFR ≥ 96.5 mL/min/1.73 m 2 . Vancomycin pharmacokinetics were calculated using the ClinCalc tool. Results ARC was in 54% of the patients. Compared with patients without ARC, those with ARC were younger and had lower serum creatinine levels. They also required higher vancomycin doses but had lower trough concentrations and 24-hour area-under-the-curve values. A significant correlation was observed between eGFR and vancomycin clearance, with eGFR > 96.5 mL/min/1.73 m 2 necessitating higher vancomycin doses (>45 mg/kg/day) to achieve the desired area under the curve to minimum inhibitory concentration ratio. Conclusion For surgical ward patients with CKD-EPI eGFR ≥ 96.5 mL/min/1.73 m 2 , a vancomycin dosage of >45 mg/kg/day may be recommended to reach effective therapeutic levels. Overall, this study emphasizes the importance of tailoring vancomycin therapy depending on renal function to ensure efficacy and mitigate the risk of antimicrobial resistance in surgical ward patients.

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Pharmacokinetics of Vancomycin in Healthy Korean Volunteers and Monte Carlo Simulations to Explore Optimal Dosage Regimens in Patients with Normal Renal Function

Kim,

Kang

et al. 2024

Antibiotics

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Background/Objectives: To date, population pharmacokinetic (PK) studies of vancomycin on healthy Korean adults have not been conducted. This study aimed to investigate the PK properties of vancomycin in healthy volunteers and to identify optimal dosing regimens based on the area under the concentration–time curve (AUC) in adult patients with normal renal function. Methods: We conducted a prospective clinical study, analysing PK samples from 12 healthy participants using noncompartmental analysis and non-linear mixed-effects modelling. The population PK parameters derived were employed in Monte Carlo simulations to evaluate the adequacy of the current dosing regimen and to formulate dosing recommendations. Results: The PK profiles were optimally described by a two-compartment model, with body weight and age as significant covariates affecting total clearance. The simulations indicated that to achieve a therapeutic target—defined as an AUC at steady-state over 24 h of 400–600 mg·h/L—daily doses ranging from 60 to 70 mg/kg are necessary in adults with normal renal function. Conclusions: This study underscores the need to actively adjust dosage and administration based on a vancomycin PK model that adequately reflects the demographic characteristics of patients to meet both safety and efficacy standards.

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Evaluation of vancomycin pharmacokinetics in patients with augmented renal clearances: A randomized clinical trial

Cited by 3 publications

References 31 publications

The Impact of Augmented Renal Clearance on Vancomycin Pharmacokinetics and Pharmacodynamics in Critically Ill Patients

The Impact of Augmented Renal Clearance on Vancomycin Pharmacokinetics and Pharmacodynamics in Critically Ill Patients

Optimize Vancomycin Dose in Surgical Ward Patients with Augmented Renal Clearance Determined by Chronic Kidney Disease Epidemiology Collaboration Equation

Pharmacokinetics of Vancomycin in Healthy Korean Volunteers and Monte Carlo Simulations to Explore Optimal Dosage Regimens in Patients with Normal Renal Function

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