Vancomycin dosing in patients undergoing maintenance hemodialysis

Rymarz, Aleksandra; Brodowska-Kania, Dorota; Gomółka, Małgorzata; Józefczak-Bergier, Elżbieta; Dzierżanowska, Małgorzata; Niemczyk, Stanisław

doi:10.1007/s11255-014-0707-0

Cited by 4 publications

(5 citation statements)

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“…Lin et al (57) described that an individualized loading dose of 15 to 20 mg/kg followed by a maintaining dose of 500 mg after each hemodialysis session provided trough serum concentrations of 10 to 20 mg/liter in 87% of patients. With a similar loading dose, Rymarz et al (58) found that 72.7% of patients reached these concentrations. Nonetheless, in the reports by Lin et al and Rymarz et al, just 68.1% and 27.2% of patients, respectively, achieved trough levels between 15 and 20 mg/liter.…”

Section: Renal Replacement Therapiesmentioning

confidence: 87%

“…The dosing vancomycin in patients undergoing intermittent hemodialysis, to achieve vancomycin trough concentrations between 15 and 20 mg/ liter, must include a loading dosage of Ϸ20 mg/kg (evidence level IIB [83]), as suggested by a study carried out to develop a vancomycin dose calculator (Vandecasteele et al [32]) and by several observational studies (Lin et al [57], Rymarz et al [58], and Jeremiah et al [59]) (data expressed as mean Ϯ SD). Thereafter, using pharmacokinetics data from 41 patients (32), the estimated doses for different intervals to the next hemodialysis may be 15, 25, and 35 mg/kg for 1-day, 2-day, and 3-day elapse times, respectively.…”

Section: Figmentioning

confidence: 99%

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Optimizing the Clinical Use of Vancomycin

Álvarez

López-Cortés

Molina

et al. 2016

Antimicrob Agents Chemother

197

124

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Pharmacists published specific guidelines about vancomycin dosage and monitoring. However, these guidelines have not been updated in the past 6 years. This review analyzes the new available information about vancomycin published in recent years regarding pharmacokinetics and pharmacodynamics, serum concentration monitoring, and optimal vancomycin dosing in special situations (obese people, burn patients, renal replacement therapy, among others). Vancomycin efficacy is linked to a correct dosage which should aim to reach an area under the curve (AUC)/MIC ratio of >400; serum trough levels of 15 to 20 mg/liter are considered a surrogate marker of an AUC/MIC ratio of >400 for a MIC of <1 mg/liter. For Staphylococcus aureus strains presenting with a MIC >1 mg/liter, an alternative agent should be considered. Vancomycin doses must be adjusted according to body weight and the plasma trough levels of the drug. Nephrotoxicity has been associated with target vancomycin trough levels above 15 mg/liter. Continuous infusion is an option, especially for patients at high risk of renal impairment or unstable vancomycin clearance. In such cases, vancomycin plasma steady-state level and creatinine monitoring are strongly indicated. Vancomycin has traditionally been used as a first-line agent for treating methicillin-resistant Staphylococcus aureus (MRSA) and other Gram-positive beta-lactam-resistant bacteria (1), which are frequent etiologies of severe health-related infections (2, 3).Although the effectiveness of vancomycin is supported by more than 5 decades of use and multiple studies, the clinical and microbiological scenario in which it is used is always changing. Attaining an appropriate dosage of vancomycin for S. aureus infections might be difficult due to the clinical impact of the creep in the MIC of vancomycin and heteroresistance among MRSA strains, or due to complex pharmacokinetic and pharmacodynamic (PK/PD) situations. In this context, the American Society of Health-System Pharmacists (ASHP), the Infectious Diseases Society of America (IDSA), and the Society of Infectious Diseases Pharmacists (SIDP) introduced a practice guideline in 2009 (4), marking a milestone in vancomycin therapy. However, several questions, such as the optimal dosing in some special clinical situations (e.g., with renal replacement therapies or in burn patients or obese patients), the role of continuous infusion, or the renal toxicity when the suggested vancomycin serum levels are achieved, remain unanswered. The present review mainly focuses on these issues. VANCOMYCIN PHARMACODYNAMICS AND ITS IMPLICATIONS FOR DRUG MONITORINGThe killing effect of vancomycin is characterized by a slow mode of action and is further hampered by a large bacterial inoculum, a stationary growth phase, and anaerobic conditions (5, 6). Although several pharmacodynamic parameters have been proposed to determine vancomycin activity, data from experimental and clinical studies have selected the area under the curve (AUC)/ MIC ratio as the best parameter to predict the...

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Section: Renal Replacement Therapiesmentioning

confidence: 87%

Section: Figmentioning

confidence: 99%

Optimizing the Clinical Use of Vancomycin

Álvarez

López-Cortés

Molina

et al. 2016

Antimicrob Agents Chemother

197

124

View full text Add to dashboard Cite

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“…The rate of drug clearance is affected by the molecular weight, protein-binding ability, water solubility, volume of distribution, and plasma clearance. For example, vancomycin has a varying volume of distribution (increases with kidney dysfunction and obesity) and protein-binding ability (decreases with kidney dysfunction) and is generally not deemed dialyzable by conventional hemodialysis 12–14 . However, in our experience, closely repeated hemodialysis sessions helped clear vancomycin and were associated with rapid improvement of the skin condition.…”

Section: Discussionmentioning

confidence: 99%

“…Although vancomycin is not generally deemed dialyzable through conventional hemodialysis 12–14 , intermittent hemodialysis using a high flux dialyzer membrane was initiated. After 3 daily treatments of hemodialysis and/or diafiltration/ultrafiltration for volume removal, vancomycin levels decreased to <5 mcg/mL and the patient’s rash markedly improved in a 24- to 48-hour period (Figure 1C).…”

Section: Report Of 3 Casesmentioning

confidence: 99%

Treatment of severe drug reactions by hemodialysis

et al. 2017

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This novel and highly effective treatment option is not considered in current algorithms for adverse drug reactions. Hence, in addition to the rarity of these reactions, the main limitation of the study is the small number of patients. Hemodialysis can substantially alter the prognosis and, in some cases, be a lifesaving treatment for patients with severe adverse cutaneous drug reaction associated with systemic toxicity.

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“…The ampicillinceftaroline combination has previously demonstrated synergy against E. faecalis in an in vitro time-kill study (38). Further study of VRE colonization with ceftaroline is needed, as the antianaerobic activity is ϳ4-to 8-fold greater than that of ceftriaxone, but biliary excretion is lower (ϳ6% excreted in feces) (39,40).…”

mentioning

confidence: 99%

Ampicillin in Combination with Ceftaroline, Cefepime, or Ceftriaxone Demonstrates Equivalent Activities in a High-Inoculum Enterococcus faecalis Infection Model

Luther

Rice

LaPlante

2016

Antimicrob Agents Chemother

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dAmpicillin-ceftriaxone combination therapy has become a predominant treatment for serious Enterococcus faecalis infections, such as endocarditis. Unfortunately, ceftriaxone use is associated with future vancomycin-resistant enterococcus colonization. We evaluated E. faecalis in an in vitro pharmacodynamic model against simulated human concentration-time profiles of ampicillin plus ceftaroline, cefepime, ceftriaxone, or gentamicin. Ampicillin-cefepime and ampicillin-ceftaroline demonstrated activities similar to those of ampicillin-ceftriaxone against E. faecalis. Enterococcus faecalis is one of the most common causes of infective endocarditis in hospitalized and/or immunocompromised patients. The combination regimen of ampicillin plus ceftriaxone has averted high-level aminoglycoside resistance (HLAR) and improved the safety profile in E. faecalis endocarditis treatment over the traditional regimen of ampicillin plus gentamicin (1-4). Accordingly, ampicillin and ceftriaxone were recently added as an option to treat both HLAR and non-HLAR E. faecalis endocarditis, according to national guidelines (5). While this regimen has increased safety for patients with serious E. faecalis infections, it may create long-term collateral damage, as ceftriaxone carries an increased risk of vancomycin-resistant Enterococcus (VRE) gastrointestinal colonization (6, 7). This increase in VRE colonization is likely due to ceftriaxone's high biliary excretion and is associated with increased risk for VRE bacteremia (6-9). Cefepime and ceftaroline are cephalosporins with different spectra of activity, distinct structures, and less biliary excretion; therefore, they should carry less risk of VRE colonization (6, 10). We therefore evaluated the activities of these dual ␤-lactam combinations that have less potential for VRE colonization in a highinoculum in vitro pharmacodynamic (IVPD) infection model (6,10,11).(A portion of the results were presented as a poster at the 54th Interscience Conference on Antimicrobial Agents and Chemotherapy [ICAAC], 8 September 2014, Washington, DC.) We evaluated two previously described strains of E. faecalis: one ampicillin-susceptible and gentamicin-susceptible strain (OG1X), and a ␤-lactamase-producing although still ampicillinsusceptible and HLAR gentamicin-resistant strain (HH22) (12, 13). Mueller-Hinton broth (MHB; Becton Dickinson, Sparks, MD, USA), adjusted to 25 mg/liter calcium and 12.5 mg/liter magnesium, was used for in vitro pharmacodynamic models (14). Colony counts were determined using tryptic soy agar (TSA; Difco, Becton Dickinson). Ampicillin (App Pharmaceuticals, Schaumberg, IL), ceftriaxone (Hospira, Lake Forest, IL), cefepime (Sagent Pharmaceuticals, Schaumberg, IL), ceftaroline research powder (Forest Laboratories, New York, NY), and gentamicin (SigmaAldrich, St. Louis, MO) were evaluated.A previously described IVPD model was used to evaluate several antibiotic regimens against enterococci at a high inoculum (ϳ10 8 CFU/ml) over 24 h (15, 16). A 250-ml working-volume glass model with ...

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Vancomycin dosing in patients undergoing maintenance hemodialysis

Cited by 4 publications

References 2 publications

Optimizing the Clinical Use of Vancomycin

Optimizing the Clinical Use of Vancomycin

Treatment of severe drug reactions by hemodialysis

Ampicillin in Combination with Ceftaroline, Cefepime, or Ceftriaxone Demonstrates Equivalent Activities in a High-Inoculum Enterococcus faecalis Infection Model

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