Validation of the Effectiveness of a Vancomycin Nomogram in Achieving Target Trough Concentrations of 15–20 mg/L Suggested by the Vancomycin Consensus Guidelines

Kullar, Ravina; Leonard, Steven N.; Davis, Susan L.; Delgado, George; Pogue, Jason M.; Wahby, Krista; Falcione, Bonnie A.; Rybak, Michael J.

doi:10.1592/phco.31.5.441

Cited by 101 publications

(115 citation statements)

References 38 publications

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“…The high-target vancomycin nomogram recently developed by Kullar and others 12 yielded validation results similar to ours, specifically 58% in a prospective test group. However, the nomogram described here offers 2 advantages: first, it can be applied to a broader target patient population; and second, it uses serum creatinine to determine dosing, rather than creatinine clearance, which alleviates the need to calculate clearance and makes bedside use of the nomogram easier.…”

Section: Predictability Of Nomogramssupporting

confidence: 81%

“…To the authors' knowledge, this is the first high-target vancomycin dosing nomogram to be developed in Canada, and we are aware of only one other published hightarget vancomycin dosing nomogram in North America. 12 Using multiple linear regression analysis of age and initial serum creatinine, a novel high-target vancomycin dosing nomogram was developed for use at the 2 study institutions. Multiple linear regression has been used successfully in previous studies to construct dosing nomograms.…”

Section: Discussionmentioning

confidence: 99%

“…8,13,14 Furthermore, several other studies have used creatinine clearance in the development of vancomycin dosing nomograms. 5,[10][11][12] As a more rigorous nomogram, an integrated nomogram was constructed and compared with the institution-specific nomograms. The validation results confirmed that the integrated nomogram could be applied at both sites.…”

Section: Discussionmentioning

confidence: 99%

“…For example, for the categories for age group 20-29 years and initial serum creatinine 40-60 µmol/L, the values used in the equation were 25 years and 50 µmol/L, respectively. The absolute dosing intervals were then rounded to standard dosing intervals for vancomycin (8,12,18,24,36, and 48 h) and used to construct the nomogram.…”

Section: Nomogram Developmentmentioning

confidence: 99%

“…However, the nomogram described here offers 2 advantages: first, it can be applied to a broader target patient population; and second, it uses serum creatinine to determine dosing, rather than creatinine clearance, which alleviates the need to calculate clearance and makes bedside use of the nomogram easier. In contrast, the nomogram of Kullar and others 12 was developed from a larger sample.…”

Section: Predictability Of Nomogramsmentioning

confidence: 99%

See 4 more Smart Citations

Development and Validation of a Novel Vancomycin Dosing Nomogram for Achieving High-Target Trough Levels at 2 Canadian Teaching Hospitals

Thalakada¹,

Legal²,

Lau³

et al. 2012

CJHP

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Section: Predictability Of Nomogramssupporting

confidence: 81%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Nomogram Developmentmentioning

confidence: 99%

Section: Predictability Of Nomogramsmentioning

confidence: 99%

See 3 more Smart Citations

Development and Validation of a Novel Vancomycin Dosing Nomogram for Achieving High-Target Trough Levels at 2 Canadian Teaching Hospitals

Thalakada¹,

Legal²,

Lau³

et al. 2012

CJHP

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The Nephrotoxicity of Vancomycin

Filippone

Kraft

Farber

2017

Clin Pharma and Therapeutics

304

274

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Vancomycin use is often associated with nephrotoxicity. It remains uncertain, however, to what extent vancomycin is directly responsible, as numerous potential risk factors for acute kidney injury frequently coexist. Herein, we critically examine available data in adult patients pertinent to this question. We review the pharmacokinetics/pharmacodynamics of vancomycin metabolism. Efficacy and safety data are discussed. The pathophysiology of vancomycin nephrotoxicity is considered. Risk factors for nephrotoxicity are enumerated, including the potential synergistic nephrotoxicity of vancomycin and piperacillin‐tazobactam. Suggestions for clinical practice and future research are given.

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Evaluation of the Effectiveness of Dose Individualization to Achieve Therapeutic Vancomycin Concentrations

Abulfathi

Chirehwa

Rosenkranz

et al. 2018

The Journal of Clinical Pharma

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The glycopeptide antibiotic vancomycin is used for treatment of methicillin-resistant Gram-positive cocci. Adequate vancomycin plasma concentrations are related to bacterial cure. However, inter- and intrapatient variability make it difficult to achieve therapeutic vancomycin concentrations. The primary objective of this study was to determine the effectiveness of using computerized therapeutic drug monitoring (TDM) to assist in achieving therapeutic vancomycin concentrations at a tertiary hospital in South Africa. This was a 2-period study consisting of a retrospective 1-month observational period followed by a prospective 1-month period in which computerized TDM was implemented as an intervention to assist with vancomycin dose individualization. During the prospective period, all vancomycin TDM results were followed by dosage individualization using computerized TDM. The retrospective period included 77 patients with 292 vancomycin concentrations: 69% (53/77) adult and 31% (24/77) pediatric patients. The prospective period included 80 patients with 217 vancomycin concentrations measured: 69% (55/80) adult and 31% (25/80) pediatric patients. Fewer vancomycin TDM data were requested during the prospective period with a median (interquartile range) of 2 (1-3) samples per patient compared with 3 (1-5) samples per patient during the retrospective period. The odds ratio of achieving therapeutic trough concentrations was 3.63 (95%CI 1.81-7.3) in the prospective period when TDM-adjusted vancomycin dosing and appropriate TDM procedures were applied. The use of computerized TDM resulted in a higher frequency of therapeutic vancomycin concentrations in a middle-income setting. Trough vancomycin concentrations alone correlate poorly with the area under plasma concentration-time curve from 0 to 24 hours.

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Validation of the Effectiveness of a Vancomycin Nomogram in Achieving Target Trough Concentrations of 15–20 mg/L Suggested by the Vancomycin Consensus Guidelines

Cited by 101 publications

References 38 publications

Development and Validation of a Novel Vancomycin Dosing Nomogram for Achieving High-Target Trough Levels at 2 Canadian Teaching Hospitals

Development and Validation of a Novel Vancomycin Dosing Nomogram for Achieving High-Target Trough Levels at 2 Canadian Teaching Hospitals

The Nephrotoxicity of Vancomycin

Evaluation of the Effectiveness of Dose Individualization to Achieve Therapeutic Vancomycin Concentrations

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