Involvement of the effect of renal hypoperfusion medications on vancomycin trough concentration: A secondary analysis using a retrospective observational data

Hirai, Toshinori; Hanada, Kazuhiko; Iwamoto, Takuya; Itoh, Toshimasa

doi:10.1111/bcpt.13646

Cited by 3 publications

(6 citation statements)

References 36 publications

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“…Moreover, data on diuretics consumption were not collected as such drugs were recently found to have potential nephrotoxic effect and elevation of vancomycin concentration. 21 While combining two drugs with known adverse effects of potential kidney impairment can be concerning, this study showed that treatment with vancomycin in the presence of a PPI was not associated with a negative impact on kidney function. However, larger studies are needed to confirm these findings.…”

Section: Discussionmentioning

confidence: 68%

“…Additionally, since only two PPIs are included in the formulary of our institution (omeprazole and pantoprazole), the potential effect of combining other PPIs with vancomycin could not be explored. Moreover, data on diuretics consumption were not collected as such drugs were recently found to have potential nephrotoxic effect and elevation of vancomycin concentration 21 …”

Section: Discussionmentioning

confidence: 99%

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Impact of combining vancomycin with proton pump inhibitors on the incidence of acute kidney injury

Aljohani

Alharbi

Basurrah

et al. 2022

Basic Clin Pharma Tox

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Vancomycin is a potent antibiotic against Gram‐positive bacteria; however, its use can be limited by nephrotoxicity. Several reports showed that proton pump inhibitors (PPIs) are associated with renal impairment. Many hospitalized patients are prescribed both drugs. As the literature lacks data on the potential augmentation of acute kidney injury (AKI) risk with this combination, we aimed to assess such risk. This was a retrospective cohort study of hospitalized patients receiving either VAN‐PPI or VAN alone for ≥72 h. Patients with a baseline serum creatinine (SCr) of ≥1.5 mg/dL were excluded. AKI incidence was assessed 3–5 days post VAN‐PPI or VAN initiation. Of 300 patients, 186 were in the VAN‐PPI group and 114 in the VAN group. The percentage of patients meeting AKI definition was not different between the two groups (11.8% vs. 7.9%; P = 0.277); however, the percentage change in SCr on Days 3–5 was only numerically higher in the VAN‐PPI group (1% vs. −2.4%; P = 0.242). The distribution of patients meeting different RIFLE class criteria was not different (P = 0.320). Using VAN with PPI was not associated with augmented AKI risk. However, monitoring kidney function would still be recommended as a standard good clinical practice when either drug is used.

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Section: Discussionmentioning

confidence: 68%

Section: Discussionmentioning

confidence: 99%

Impact of combining vancomycin with proton pump inhibitors on the incidence of acute kidney injury

Aljohani

Alharbi

Basurrah

et al. 2022

Basic Clin Pharma Tox

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“…The five observational cohort studies included in this review are summarized in Table 2 . In three studies, data were collected prospectively [ 24 , 25 , 26 ], whereas, in two studies, data were collected retrospectively [ 27 , 28 ]. Patient populations differed significantly within each study, ranging from neonates to adults scheduled for brain surgery.…”

Section: Resultsmentioning

confidence: 99%

“…The reason for this is unclear and suggests that the effect of furosemide on vancomycin V d in this study may have been biased. Hirai et al [ 28 ] demonstrated through multiple linear regression analyses that the combination of a loop/thiazide diuretic was associated with a statistically significant increase in vancomycin trough (+4.47 mg/L). However, this finding was only at the initial dosing period and did not remain statistically significant when exploring the final or mean vancomycin troughs; moreover, it was not significant with loop diuretics alone.…”

Section: Resultsmentioning

confidence: 99%

Systematic Review and Meta-Analysis of the Effect of Loop Diuretics on Antibiotic Pharmacokinetics

et al. 2023

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Loop diuretics and antibiotics are commonly co-prescribed across many clinical care settings. Loop diuretics may alter antibiotic pharmacokinetics (PK) via several potential drug interactions. A systematic review of the literature was performed to investigate the impact of loop diuretics on antibiotic PK. The primary outcome metric was the ratio of means (ROM) of antibiotic PK parameters such as area under the curve (AUC) and volume of distribution (Vd) on and off loop diuretics. Twelve crossover studies were amenable for metanalysis. Coadministration of diuretics was associated with a mean 17% increase in plasma antibiotic AUC (ROM 1.17, 95% CI 1.09–1.25, I2 = 0%) and a mean decrease in antibiotic Vd by 11% (ROM 0.89, 95% CI 0.81–0.97, I2 = 0%). However, the half-life was not significantly different (ROM 1.06, 95% CI 0.99–1.13, I2 = 26%). The remaining 13 observational and population PK studies were heterogeneous in design and population, as well as prone to bias. No large trends were collectively observed in these studies. There is currently not enough evidence to support antibiotic dosing changes based on the presence or absence of loop diuretics alone. Further studies designed and powered to detect the effect of loop diuretics on antibiotic PK are warranted in applicable patient populations.

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“…For example, in a recent study, furosemide was reported to affect the trough concentration in a multivariate analysis. 37) Age, eGFR, and BMI ≥ 25 kg/m 2 were extracted as predictive variables of our model, and these factors may have been affected by other variables such as disease history and concomitant drugs. Using all factors of patient in DT analysis, may result in unknown combinations; however, it is difficult to determine whether those combinations correspond to clinical background; hence, for better clinical interpretation, we used factors shown to change VCM concentration in previous studies.…”

Section: Discussionmentioning

confidence: 99%

Machine Learning-Based Model for Estimating Vancomycin Maintenance Dose to Target the Area under the Concentration Curve of 400–600 mg·h/L in Japanese Patients

Miyai

Imai

Yoshimura

et al. 2022

Biological & Pharmaceutical Bulletin

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In therapeutic drug monitoring of vancomycin (VCM), the area under the concentration-time curve (AUC) is related to clinical efficacy and toxicity. Determining the maintenance for patient is necessary since VCM concentrations are affected by factors such as renal function. We constructed a machine learning-based model to estimate the maintenance dose to target an AUC of 400-600 mg⋅h/L in each combination of patient's factors. This retrospective observational study was conducted at two hospitals. Patients who received VCM intravenously with measured trough and another point (e.g., peak) concentrations within the November 2011 to March 2019 period were enrolled. We extracted the factors that affect VCM concentration and constructed a decision tree model using a classification and regression tree algorithm. Of the 1380 patients, 822 were included. Training data were split up to four times and included 24 subgroups. The average corrected VCM daily doses ranged 17.6-59.4 mg/kg. Estimated glomerular filtration rate, age, and body mass index were selected as predictive variables that affected the recommended daily dose. In the validation data, our model had slightly higher proportions of AUC of 400-600 mg⋅h/L than other nomograms. However, our model was based only on limited patients. Thus, further clinical studies are needed to develop a general-purpose model in the future. We successfully constructed a model that recommends VCM maintenance daily doses with AUC of 400-600 mg⋅h/L for each combination of independent variables. Our model has the potential for application as a simple decision-making tool for medical staff.

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Involvement of the effect of renal hypoperfusion medications on vancomycin trough concentration: A secondary analysis using a retrospective observational data

Cited by 3 publications

References 36 publications

Impact of combining vancomycin with proton pump inhibitors on the incidence of acute kidney injury

Impact of combining vancomycin with proton pump inhibitors on the incidence of acute kidney injury

Systematic Review and Meta-Analysis of the Effect of Loop Diuretics on Antibiotic Pharmacokinetics

Machine Learning-Based Model for Estimating Vancomycin Maintenance Dose to Target the Area under the Concentration Curve of 400–600 mg·h/L in Japanese Patients

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