The relationship between trough concentration of vancomycin and effect on methicillin-resistant Staphylococcus aureus in critically ill patients

Cheong, Jamie; Makmor-Bakry, Mohd; Lau, Chee Lan; Rahman, Raha Abdul

doi:10.7196/samj.5343

Cited by 21 publications

(19 citation statements)

References 13 publications

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“…The vancomycin trough concentrations were similar in the therapy responder and non-responder groups. This finding however contradicted previous reports by Cheong et al [3] and Zelenitsky et al [16]. Both studies found that higher vancomycin trough concentrations were associated with improves treatment outcomes.…”

Section: Discussioncontrasting

confidence: 80%

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Association between single trough-based area under the curve estimation of vancomycin and treatment outcome among methicillin-resistant Staphylococcus aureus bacteremia patients

Makmor‐Bakry

Ahmat

Shamsuddin

et al. 2019

ait

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Methicillin-resistant Staphylococcus aureus (MRSA) is amongst the most serious infections of hospitalized patients. MRSA infections are associated with high mortality, especially amongst critically ill patients [1]. A recent clinical guideline recommends a higher serum trough concentration (15-20 μg mL-1) for patients with complicated MRSA bacteremia [2]. Even though a higher trough concentrations has being associated with a better treatment response [3], clinical failure remains common even in patients who have achieved the recommended target for vancomycin trough con

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Section: Discussioncontrasting

confidence: 80%

“…Commonly, vancomycin trough concentration alone has being used to predict vancomycin treatment efficacy. However, conflicting evidence has been published for the relationship between vancomycin trough concentration and treatment response [3][4][5]. The pharmacokinetic/pharmacodynamic (PK/PD) profiles for vancomycin have being investigated over the past decade.…”

mentioning

confidence: 99%

Association between single trough-based area under the curve estimation of vancomycin and treatment outcome among methicillin-resistant Staphylococcus aureus bacteremia patients

Makmor‐Bakry

Ahmat

Shamsuddin

et al. 2019

ait

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“…Vancomycin is given for humans by the intravenous route in the prophylaxis when there is a high risk of methicillin-resistant staphylococci and treatment of endocarditis, osteomyelitis, acute bacterial prostatitis and other serious infections caused by Gram positive cocci [25].Human patients with normal renal function should receive an initial dosage of 6.5 to 8 mg of vancomycin per kg intravenously over 1 hour every 6 to 12 hour [26,27].However, the practical dosing intervals can be 8, 12, 24, and 48 hour based on the creatinine clearance of the patient [28].…”

Section: Therapeutic Indications Of Vancomycinmentioning

confidence: 99%

<strong>Review on Usage of Vancomycin in Livestock and Humans: Maintaining its Efficacy, Prevention of Resistance and Alternative Therapy</strong>

Wijesekara

Kumbukgolla

Jayaweera

et al. 2016

Preprint

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Vancomycin is one of the 'last-line' classes of antibiotics used in the treatment of life-threatening infections caused by Gram-positive bacteria. Even though vancomycin was discovered in 1950s it was widely used after 1980s for the treatment of infections caused by methicillin-resistant Staphylococci as prevalence of such strains were increased.However, currently it is evident that vancomycin resistant Staphylococcusaureusandvancomycin-resistant Enterococci have been developed as a result of variousreasons including use of avaparcin, which is an analog of vancomycin, as feed additive in livestock. In present day context, more attention should be paid on prevention of emergence of resistance for the antibiotics in order to keep antibiotics effective. In order to prevent emergence of resistance, proper guidance for the responsible use of antimicrobials is indispensable. Therefore, almost all stakeholders who use antibiotics should have in depth understanding on the antibiotic they use. As such, it is imperative to be aware of the important aspects of vancomycin. In the present review, efforts have been made to discussthe pharmacokinetics and pharmacodynamics, indications, emergence of resistance, control of resistance, adverse effects and alternative therapy for vancomycin.

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“…Similarly controversy exists with respect to ototoxicity 173,174 as well as benefit in clinical outcome. 90,171,[175][176][177] A meta-analysis by Ye et al 178 suggested TDM significant increases in the likelihood of clinical efficacy and decreases the rate of nephrotoxicity. There is also a good agreement in the benefit of TDM to prevent the emergence of vancomycin resistant organisms with trough concentration above 10 mg/L.…”

Section: Vancomycinmentioning

confidence: 99%

“…There is also a good agreement in the benefit of TDM to prevent the emergence of vancomycin resistant organisms with trough concentration above 10 mg/L. 177,179,180 Selection of patients TDM is warranted to avoid toxicity in patients receiving high doses; during concomitant therapy with other nephrotoxic or ototoxic agents, in patients with unstable renal function, those receiving prolonged therapy (> 3 to 5 days), during RRT and in hemodynamically unstable critically ill septic patients. 89,181 Sampling time…”

Section: Vancomycinmentioning

confidence: 99%

A pharmacokinetic/pharmacodynamic and clinical outcome evaluation of beta-lactam antibiotic therapeutic drug monitoring in critically ill patients

Wong¹

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Disease-processes experienced by critically ill patients commonly cause unique pharmacokinetic (PK) changes, that may result in drug concentrations that are either subtherapeutic or toxic when dosing is based on PK data obtained from non-critically ill patients. Ensuring therapeutic dosing of beta-lactam antibiotics in critically ill patient is of increasing concern, given the difficult-to-predict PK in this population, frequent use of this antibiotic class in treating severe infections and the importance of optimal antibiotic therapy for reducing mortality rates. Therapeutic drug monitoring (TDM), a strategy frequently used in dosing drugs with complex PK, has demonstrated potential clinical advantages for improving dosing of beta-lactams in the critically ill. However, the practice of beta-lactam TDM and dose optimisation is still limited by a number of factors. Large-scale data on the adequacy of current dosing regimens and optimal PK/pharmacodynamic (PK/PD) targets associated with maximal clinical outcome is still limited. In particular, currently available data on betalactam TDM have not adequately quantified the potentially profound impact of hypoalbuminaemia, common among the critically ill, on the PK of the pharmacologically active unbound concentration of beta-lactams. This Thesis aims to describe the application of a beta-lactam TDM-guided dosing program in critically ill patients, with the utilization of directly-measured unbound drug concentration data. Specifically, this work will first characterise the impact of altered protein binding in critically ill patients on the accuracy of commonly used methods for calculation of unbound beta-lactam concentrations (from measured total concentrations). Secondly, this work will describe the achievement of PK/PD targets in relation to directly-measured unbound betalactam concentrations in critically ill patients receiving empiric dosed and TDM-guided betalactam antibiotic treatments. Finally, the association of beta-lactam concentrations with clinical outcome in critically ill patients with blood stream infections will also be characterised. This Thesis comprises of seven chapters. Chapter one introduces relevant PK/PD and betalactam dosing concepts for this Thesis. Chapter two includes a published review article that systemically analyses the current literature at the time on the risk of inadequate drug exposure in critically ill patients and V Publications included in this Thesis Wong G, Sime FB, Lipman J, Roberts JA. How do we use therapeutic drug monitoring to improve outcomes from severe infections in critically ill patients? BMC Infectious Diseases.

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The relationship between trough concentration of vancomycin and effect on methicillin-resistant Staphylococcus aureus in critically ill patients

Cited by 21 publications

References 13 publications

Association between single trough-based area under the curve estimation of vancomycin and treatment outcome among methicillin-resistant Staphylococcus aureus bacteremia patients

Association between single trough-based area under the curve estimation of vancomycin and treatment outcome among methicillin-resistant Staphylococcus aureus bacteremia patients

<strong>Review on Usage of Vancomycin in Livestock and Humans: Maintaining its Efficacy, Prevention of Resistance and Alternative Therapy</strong>

A pharmacokinetic/pharmacodynamic and clinical outcome evaluation of beta-lactam antibiotic therapeutic drug monitoring in critically ill patients

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