Pharmacokinetics of vancomycin in adult cystic fibrosis patients

Abstract

Although the depositions of many antibiotics are altered in cystic fibrosis patients, that of vancomycin has not been studied. To assess vancomycin pharmacokinetics, 10 adult cystic fibrosis patients were given a parenteral dose of vancomycin (15 mg/kg) during the first 72 h of hospitalization for acute bronchopulmonary exacerbation. Blood samples were obtained at 0, 1, 1.25, 1.5, 2, 3, 4, 6, 8, 12, 15, and 24 h. The mean (standard deviation) weight, measured creatinine clearance, and Taussig clinical score were 51 (13) kg, 130 (39) ml/min/1.73 m2, and 64 (13), respectively. Multicompartmental pharmacokinetic parameters were best described by a two-compartment model. The mean (standard deviation) volume of distribution, total body clearance, and terminal elimination rate constant were 0.58 (0.15) liter/kg, 91 (19) ml/min/1.73 m2, and 0.123 (0.05) h-1, respectively. These values were consistent with vancomycin pharmacokinetic parameters obtained in previous studies of healthy adult volunteers. Vancomycin dosages predicted by using a two-compartment Bayesian model were approximately 15 mg/kg every 8 to 12 h. There were poor correlations between clinical score or creatinine clearance and any pharmacokinetic parameter (r values of < 0.32). The coefficient of correlation between urine flow rate and total body clearance was 0.7 (P < 0.05). Adult cystic fibrosis patients exhibit a disposition of vancomycin similar to that exhibited by healthy adults, and thus cystic fibrosis does not alter vancomycin pharmacokinetics.

Restricting the Selection of Antibiotic‐Resistant Mutant Bacteria: Measurement and Potential Use of the Mutant Selection Window

“…when calculated. a References for pharmacokinetic and dosing information were as follows: tobramycin [8], chloramphenicol [9], rifampicin [10], penicillin G [11], vancomycin [12], ciprofloxacin [7], and other quinolones [13]. b The longest dosing interval was calculated by DI ¼ t 1=2 £ log 2 ðC max =MPCÞ, where t 1/2 is the half-life of the plasma drug concentration.…”

The cumulative effects of intravenous antibiotic treatments on hearing in patients with cystic fibrosis

“…Paper-based medical records prior to 2007 were also examined for IV–AG and vancomycin dosing data. Vancomycin was included in the review because it can potentiate the cochleotoxicity of AGs (7, 19, 37–40), and is typically given to patients colonized with methicillin-resistant Staphylococcus aureus (MRSA) as clinical standard of care (41). All participants treated with aminoglycosides received clinical doses of either tobramycin and/or amikacin, which appear to have equivalent ototoxic potential, as reported previously (42–44).…”

Relationship between vancomycin dosage and serum trough vancomycin concentrations in pediatric patients with cystic fibrosis

“…In one small study, 10 adult patients with CF demonstrated vancomycin pharmacokinetic values similar to those in healthy adults without CF. 8 However, pediatric patients with CF are known to have altered pharmacokinetic values compared with healthy pediatric patients. One trial of 67 children (mean ± S.D.…”