TDM coupled with Bayesian forecasting should be considered an invaluable tool for optimizing vancomycin daily exposure in unstable critically ill patients

Pea, Federico; Bertolissi, M; Silvestre, Alessia Di; Poz, Donatella; Giordano, Francesco; Furlanut, Mario

doi:10.1016/s0924-8579(02)00188-7

Cited by 52 publications

(31 citation statements)

References 26 publications

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“…7,20,24,25 Cutler et al and Pea et al attempted to find a correlation between UO and Cl Van in healthy subjects and ICU patients 26,27 ; however, their results did not reveal any association. The lack of association between Cl Van and UO in previous studies might be due to a lack of significantly higher UO in these populations.…”

Section: Discussionmentioning

confidence: 95%

A Larger Dose of Vancomycin Is Required in Adult Neurosurgical Intensive Care Unit Patients Due to Augmented Clearance

Liu

Yang

et al. 2015

Therapeutic Drug Monitoring

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Section: Discussionmentioning

confidence: 95%

A Larger Dose of Vancomycin Is Required in Adult Neurosurgical Intensive Care Unit Patients Due to Augmented Clearance

Liu

Yang

et al. 2015

Therapeutic Drug Monitoring

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“…Among 780 patients who received the standard daily dose administered as two to four daily doses, the C min at 36 to 48 h after the start of therapy was Ͻ10 mg/liter in 45.1% of the cases (13). Importantly, an even lower C min may be expected during conventional vancomycin therapy in critically ill patients who present with pathophysiological and/or iatrogenic conditions that may cause an enlargement of the extracellular space and/or an increase in the renal clearance of hydrophilic antimicrobials (21,25). In an old study carried out with febrile neutropenic patients with acute leukemia empirically treated with vancomycin at a mean daily dose of 15 mg/kg every 12 h, the C min on day 3 was Ͻ5 mg/liter in as many as 56% of the cases (22).…”

Section: Discussionmentioning

confidence: 99%

“…Considering that vancomycin is mainly eliminated by glomerular filtration (17), the correlation between individual CL v and CL Cr estimates according to the formula of Cockcroft and Gault (3) was assessed by linear regression. In order to avoid the potential inaccuracy of CL Cr estimates for patients who had been bedridden for a long time (21), only patients with recent hospital admission (Ͻ14 days) were included in this analysis.…”

Section: Methodsmentioning

confidence: 99%

Prospectively Validated Dosing Nomograms for Maximizing the Pharmacodynamics of Vancomycin Administered by Continuous Infusion in Critically Ill Patients

Pea

Furlanut

Negri

et al. 2009

Antimicrob Agents Chemother

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111

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“…This was shown to be the case not only for aminoglycosides [42][43][44] and glycopeptides [16,[45][46][47], namely those antimicrobials traditionally considered at high toxicity risk, but also for safer agents like the beta-lactams [48][49][50][51][52], which to date are still considered the cornerstone of Fig. (4).…”

Section: Call For Individualization Of Antimicro-bial Dosing In Critimentioning

confidence: 99%

Plasma Pharmacokinetics of Antimicrobial Agents in Critically Ill Patients

Pea

2013

Current Clinical Pharmacology

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Prompt optimal antimicrobial treatment in critically ill patients is mandatory and must be achieved not only in terms of spectrum of activity, but also in terms of exposure at the infection site. Plasma profile of antimicrobial agents may represent a valid surrogate marker of drug exposure and allow to identify the correct dosage for a given drug. However, in the critically ill patients the pharmacokinetic behavior of antimicrobials may be altered by some very peculiar pathophysiological conditions, so that dosages significantly different from those used in clinically stable patients or from those originally studied in healthy volunteers for regulatory purposes may often be needed in order to ensure optimal plasma drug exposure in such population. This is especially true for hydrophilic antimicrobials (aminoglycosides, beta-lactams, glycopeptides, lipopeptides, echinocandins, fluconazole, acyclovir, ganciclovir) whose volume of distribution and clearance may be significantly altered by these conditions. These aspects are particularly relevant in patients with severe sepsis or with septic shock for whom the time for being considered as a special population to be studied apart from the general population has probably come. From the healthcare system perspective, this means that individualization of antimicrobial therapy by means of a real time therapeutic drug monitoring coupled with clinical pharmacological advice should be considered an invaluable tool for optimizing antimicrobial therapy and for the containment of microbial resistance in this setting.

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TDM coupled with Bayesian forecasting should be considered an invaluable tool for optimizing vancomycin daily exposure in unstable critically ill patients

Cited by 52 publications

References 26 publications

A Larger Dose of Vancomycin Is Required in Adult Neurosurgical Intensive Care Unit Patients Due to Augmented Clearance

A Larger Dose of Vancomycin Is Required in Adult Neurosurgical Intensive Care Unit Patients Due to Augmented Clearance

Prospectively Validated Dosing Nomograms for Maximizing the Pharmacodynamics of Vancomycin Administered by Continuous Infusion in Critically Ill Patients

Plasma Pharmacokinetics of Antimicrobial Agents in Critically Ill Patients

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