Loading dose of vancomycin in critically ill patients: 15mg/kg is a better choice than 500mg

Mohammedi, I.; Descloux, Élodie; Argaud, Laurent; Scanff, J. Le; Robert, Dominique

doi:10.1016/j.ijantimicag.2005.11.009

Cited by 37 publications

(45 citation statements)

References 19 publications

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“…However, this practice was not used in recent clinical trials [31,32]. On the basis of the increase in hVISA associated with initial low vancomycin concentrations [10], various in vitro observations associated with the emergence of hVISA with low vancomycin exposures [13], reports of clinical failures with hVISA [12], and the improved outcomes associated with early empirical [28] plus aggressive vancomycin dosing [24,33], the need for vancomycin loading doses should be reevaluated.…”

Section: Are We Administering the Correct Vancomycin Dose At The Righmentioning

confidence: 99%

Point: Vancomycin Is Not Obsolete for the Treatment of Infection Caused by Methicillin-Resistant Staphylococcus aureus

Mohr¹,

Murray²

2007

Clinical Infectious Diseases

163

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Since the discovery, development, and US Food and Drug Administration approval of vancomycin in the 1950s, this agent has remained a mainstay for the treatment of infections caused by methicillin-resistant Staphylococcus aureus (MRSA). However, because of the development of new antistaphylococcal antibiotics and reports of vancomycin failures, the utility of vancomycin has recently been questioned. Although vancomycin did not undergo the strict US Food and Drug Administration approval process that is in place today to demonstrate efficacy, there is considerable information available that sheds light on the role vancomycin has in infectious diseases pharmacotherapy today. In addition, although we look to in vitro susceptibility testing to assess vancomycin activity against S. aureus, we have come to appreciate that resistance of S. aureus to vancomycin can be a continuous--rather than a categorical--phenomenon. This has resulted in clinical microbiology laboratories having difficulty identifying S. aureus that may not respond to conventional doses of vancomycin. A better understanding is needed of the pharmacodynamic relationship between vancomycin and MRSA as relates to optimal dosing strategies, including consideration for loading doses, and development of rational categorical breakpoints for susceptibility based on clinical outcomes. By better understanding these critical issues, it may be possible to optimize the use of vancomycin, resulting in a cost-effective treatment option for many patients infected with MRSA.

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Section: Are We Administering the Correct Vancomycin Dose At The Righmentioning

confidence: 99%

Point: Vancomycin Is Not Obsolete for the Treatment of Infection Caused by Methicillin-Resistant Staphylococcus aureus

Mohr¹,

Murray²

2007

Clinical Infectious Diseases

163

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“…This assumption was validated by the parallel reduction of vancomycin-related AKI that followed technological improvement in the fermentation process, which led to a 95% level of product purity by 1985 [Bailie and Neal, 1988]. The incidence of vancomycin-induced nephrotoxicity (VIN) was reported to range from 5% to 7% [Farber and Moellering, 1983;Mohammedi et al 2006]. In addition, earlier studies showed there was an inconsistent dosetoxicity relationship while there was failure to establish causality in experimental animal studies [Cantu et al 1994].…”

Section: Introductionmentioning

confidence: 99%

Review of vancomycin-induced renal toxicity: an update

Bamgbola

2016

Therapeutic Advances in Endocrinology

180

145

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Abstract:In recent times the use of larger doses of vancomycin aimed at curbing the increasing incidence of resistant strains of Staphylococcus aureus has led to a wider report of acute kidney injury (AKI). Apart from biological plausibility, causality is implied by the predictive association of AKI with larger doses, longer duration, and graded plasma concentrations of vancomycin. AKI is more likely to occur with the concurrent use of nephrotoxic agents, and in critically ill patients who are susceptible to poor renal perfusion. Although most vancomycin-induced AKI cases are mild and therefore reversible, their occurrence may be associated with greater incidence of end-stage kidney disease and higher mortality rate. The strategy for its prevention includes adequate renal perfusion and therapeutic drug monitoring in high-risk individuals. In the near future, there is feasibility of renoprotective use of antioxidative substances in the delivery of vancomycin.

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“…Although there is no strong evidence to support the real clinical impact of this method, it has been suggested that its use is associated with better clinical cure rates in critically ill patients (24). In fact, the use of the LD allows optimal serum concentrations to be reached quickly, which improves the start of adequate antibiotic therapy.…”

Section: Discussionmentioning

confidence: 99%

Pharmacokinetic Assessment of Vancomycin Loading Dose in Critically Ill Patients

Álvarez

Plaza‐Plaza

Ramírez

et al. 2017

Antimicrob Agents Chemother

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The vancomycin loading dose (LD) of 25 to 30 mg/kg is a frequently practiced strategy to achieve effective concentrations from the first-treatment dose. However, considering only the body weight for dosing might be inadequate in critically ill patients due to pharmacokinetics changes. We sought to assess achieving optimal trough serum levels of vancomycin and AUC 0 -24 /MIC in the first 24 h of treatment by using an LD based on population pharmacokinetic parameters of critically ill patients. We performed a concurrent cohort study over 22 months of patients with severe sepsis who received intravenous vancomycin. The patients were treated with three different strategies to initiate vancomycin: without an LD (group A), with an LD of 25 to 30 mg/kg (group B), and with an LD based on population pharmacokinetic parameters of the critically ill patient (group C). An optimal trough serum concentration was achieved in 5, 9, and 83% of patients in groups A, B, and C, respectively. The number of patients that reached optimal AUC 0 -24 was 2 of 18 (11%), 5 of 11 (46%), and 11 of 12 (92%) in groups A, B, and C, respectively. The statistical analysis for both parameters revealed significant differences in group C with respect to other groups. The administration of the LD calculated from population pharmacokinetic parameters from the beginning of therapy is a more efficient strategy to obtain adequate trough serum concentrations and AUC 0 -24 /MIC in critical patients.

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Loading dose of vancomycin in critically ill patients: 15mg/kg is a better choice than 500mg

Cited by 37 publications

References 19 publications

Point: Vancomycin Is Not Obsolete for the Treatment of Infection Caused by Methicillin-Resistant Staphylococcus aureus

Point: Vancomycin Is Not Obsolete for the Treatment of Infection Caused by Methicillin-Resistant Staphylococcus aureus

Review of vancomycin-induced renal toxicity: an update

Pharmacokinetic Assessment of Vancomycin Loading Dose in Critically Ill Patients

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