Pharmacokinetics of and maintenance dose recommendations for vancomycin in severe pneumonia patients undergoing continuous venovenous hemofiltration with the combination of predilution and postdilution

Li, Qiang; Liang, Fenghua; Sang, Ling; Li, Pengpeng; Lv, Bijun; Tan, Lu; Liu, Xiaoqing; Chen, Wenying

doi:10.1007/s00228-019-02755-5

Cited by 17 publications

(19 citation statements)

References 19 publications

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“…Dose recommendations for vancomycin in CRRT vary widely in the literature from 500 mg every 12 h, to 1000 mg every 48 h, to continuous infusions 9–13 . Researchers have found that vancomycin concentrations are often subtherapeutic in patients on CRRT 14–16 .…”

Section: Discussionmentioning

confidence: 99%

“…Dose recommendations for vancomycin in CRRT vary widely in the literature from 500 mg every 12 h, to 1000 mg every 48 h, to continuous infusions. [9][10][11][12][13] Researchers have found that vancomycin concentrations are often subtherapeutic in patients on CRRT. [14][15][16] A study by Franzee et al found that only 37% of patients achieved target trough concentration, defined as 10-15 mcg/ml or 15-20 mg/L, when vancomycin was dosed based on institutional guidelines of 15-20 mg/ kg every 24 h. Failure to achieve target trough was more common in patients on high ultrafiltration rates of >30 ml/kg/h.…”

Section: Pharmacokinetic Data Provided By Neely Et Al Demonstrated High Inter-mentioning

confidence: 99%

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Evaluation of dosing strategies and trough concentrations of vancomycin in patients undergoing continuous venovenous hemofiltration

et al. 2021

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Study Objective: Recommendations regarding vancomycin dosing in critically ill patients on continuous venovenous hemofiltration (CVVH) are limited. The purpose of this study was to evaluate current dosing practices of pharmacists for patients treated with CVVH, develop guidelines for optimal dosing and monitoring of vancomycin to improve target trough attainment, and reduce pharmacist workload.Design: A retrospective cohort study. was performed of critically ill adult patients from January 2015 to December 2018. Patients were included if they received vancomycin during CVVH for at least 48 h. Patients with significant residual kidney function, defined as daily urine output >400 ml or significant fluctuations (≥1000 ml/h in a 24-h period) in their hemofiltration rates, were excluded. Interruptions in CVVH up to 6 h/day were permitted. Dosing strategies with two dosing categories were defined:(1) dosing based on random serum levels (dosing by level, DBL) or (2) scheduled vancomycin dosing (SD).Setting: Academic medical center in Detroit, Michigan.Patients: Critically ill adult patients. Measurements and Main Results:During the study period, 942 patients were evaluated and 200 met inclusion criteria, for a total of 586 serum vancomycin levels. There were 141 patients with 443 random vancomycin serum levels in the DBL group and 59 patients with143 vancomycin trough levels in the SD group. Mean vancomycin trough levels were similar between groups (17.1 ± 6 vs. 16.5 ± 4 mcg/ml) for the DBL and SD groups, respectively. For the primary end point of overall target trough achievement of 15-20 mcg/ml, significantly more trough levels in the SD group were in the 15-20 mcg/ml range compared with the DBL group, 50% vs. 38%; p < 0.001, respectively.When target trough range was extended to 10-20 mcg/ml, success rates were similar between groups (74% DBL vs. 82% SD, p = 0.021). The number of interventions required by the pharmacist, including notes per day and orders per day, were reduced by approximately 50% when the SD strategy was utilized. Scheduled vancomycin dosing regimens of 15-22 mg/kg every 12-24 h were required to yield trough levels in the 15-20 mcg/ml range.Conclusions: Target vancomycin trough achievement of 15-20 mcg/ml occurred more frequently when vancomycin was scheduled at a dose of 15-22 mg/kg every 12-24 h | 555 WAHBY et Al.

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Section: Discussionmentioning

confidence: 99%

Section: Pharmacokinetic Data Provided By Neely Et Al Demonstrated High Inter-mentioning

confidence: 99%

Evaluation of dosing strategies and trough concentrations of vancomycin in patients undergoing continuous venovenous hemofiltration

et al. 2021

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“…Previous studies showed quite different recommendations on vancomycin dosage under CVVH. Chaijamorn W indicated the maintenance dose of vancomycin would be 500-750 mg q12h to provide a trough concentration of 15-20 mg/L under CVVH with an ultrafiltrate flow rate of 800-1,200 ml/h (Chaijamorn et al, 2011), while Qiang Li recommended vancomycin 400-650 mg q12h under CVVH with an ultrafiltrate flow rate of 30-40 mg/kg/h (Li et al, 2020). The latest study showed a higher dose (total dose ≥2.75g/day) of vancomycin than the current recommendation (highest literature-based dosing regimen: 1.5 g/day) was needed in CRRT patients with vancomycin MIC ≥ 1 mg/L (Charoensareerat et al, 2019).…”

Section: Vancomycinmentioning

confidence: 99%

Recommendation of Antimicrobial Dosing Optimization During Continuous Renal Replacement Therapy

Xia

et al. 2020

Front. Pharmacol.

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Continuous Renal Replacement Therapy (CRRT) is more and more widely used in patients for various indications recent years. It is still intricate for clinicians to decide a suitable empiric antimicrobial dosing for patients receiving CRRT. Inappropriate doses of antimicrobial agents may lead to treatment failure or drug resistance of pathogens. CRRT factors, patient individual conditions and drug pharmacokinetics/pharmacodynamics are the main elements effecting the antimicrobial dosing adjustment. With the development of CRRT techniques, some antimicrobial dosing recommendations in earlier studies were no longer appropriate for clinical use now. Here, we reviewed the literatures involving in new progresses of antimicrobial dosages, and complied the updated empirical dosing strategies based on CRRT modalities and effluent flow rates. The following antimicrobial agents were included for review:

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“…However, the optimal dose of vancomycin in critically ill patients receiving CVVH remains unclear. Several studies [11,[20][21][22][23] have investigated the topic, but their recommendations are controversial. Besides, the covariates of these studies were not fully considered, and most studies only recommended dosage regimens of one subgroup, which restricts the applicability to other patients.…”

Section: Introductionmentioning

confidence: 99%

Dose Optimization of Vancomycin for Critically Ill Patients Undergoing CVVH: A Prospective Population PK/PD Analysis

Wang

Zhang

et al. 2021

Antibiotics

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The optimal dose of vancomycin in critically ill patients receiving continuous venovenous hemofiltration (CVVH) remains unclear. The objective of this study was to identify factors that significantly affect pharmacokinetic profiles and to further investigate the optimal dosage regimens for critically ill patients undergoing CVVH based on population pharmacokinetics and pharmacodynamic analysis. A prospective population pharmacokinetic analysis was performed at the surgical intensive care unit in a level A tertiary hospital. We included 11 critically ill patients undergoing CVVH and receiving intravenous vancomycin. Serial blood samples were collected from each patient, with a total of 131 vancomycin concentrations analyzed. Nonlinear mixed effects models were developed using NONMEM software. Monte Carlo Simulation was used to optimize vancomycin dosage regimens. A two-compartment model with first-order elimination was sufficient to characterize vancomycin pharmacokinetics for CVVH patients. The population typical vancomycin clearance (CL) was 1.15 L/h and the central volume of distribution was 16.9 L. CL was significantly correlated with ultrafiltration rate (UFR) and albumin level. For patients with normal albumin and UFR between 20 and 35 mL/kg/h, the recommended dosage regimen was 10 mg/kg qd. When UFR was between 35 and 40 mL/kg/h, the recommended dosage regimen was 5 mg/kg q8h. For patients with hypoalbuminemia and UFR between 20 and 25 mL/kg/h, the recommended dosage regimen was 5 mg/kg q8h. When UFR was between 25 and 40 mL/kg/h, the recommended dosage regimen was 10 mg/kg q12h. We recommend clinicians choosing the optimal initial vancomycin dosage regimens for critically ill patients undergoing CVVH based on these two covariates.

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Pharmacokinetics of and maintenance dose recommendations for vancomycin in severe pneumonia patients undergoing continuous venovenous hemofiltration with the combination of predilution and postdilution

Cited by 17 publications

References 19 publications

Evaluation of dosing strategies and trough concentrations of vancomycin in patients undergoing continuous venovenous hemofiltration

Evaluation of dosing strategies and trough concentrations of vancomycin in patients undergoing continuous venovenous hemofiltration

Recommendation of Antimicrobial Dosing Optimization During Continuous Renal Replacement Therapy

Dose Optimization of Vancomycin for Critically Ill Patients Undergoing CVVH: A Prospective Population PK/PD Analysis

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