Vancomycin Dosing Practices, Trough Concentrations, and Predicted Area Under the Curve in Children With Suspected Invasive Staphylococcal Infections

Chhim, Rebecca F.; Arnold, Sandra R.; Lee, K. R.

doi:10.1093/jpids/pit032

Cited by 10 publications

(17 citation statements)

References 8 publications

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“…Therefore, uncertainty remains surrounding the appropriate vancomycin dosing regimen and target trough concentration in pediatric patients. Recent attention has been given to studies of optimal dosing regimens, goal trough concentrations, and clinical outcomes based on the correlation of vancomycin trough concentration with predicted area under the curve in children . However, little attention has been focused on potential toxicities in the pediatric population.…”

mentioning

confidence: 99%

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Assessment of Initial Serum Vancomycin Trough Concentrations and Their Association with Initial Empirical Weight-Based Vancomycin Dosing and Development of Nephrotoxicity in Children: A Multicenter Retrospective Study

et al. 2015

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mentioning

confidence: 99%

“…Although two trials found high serum trough concentrations as a risk factor, total daily vancomycin dose was not observed to be associated with nephrotoxicity. This is an essential finding because aggressive dosing of vancomycin 15 mg/kg every 6 hours intravenously is proposed to achieve target trough concentrations above 15 mg/L for MRSA infections …”

mentioning

confidence: 99%

Assessment of Initial Serum Vancomycin Trough Concentrations and Their Association with Initial Empirical Weight-Based Vancomycin Dosing and Development of Nephrotoxicity in Children: A Multicenter Retrospective Study

et al. 2015

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“…12 It may also be that trough measurement is not the optimal approach to monitoring vancomycin efficacy and safety. 13 There is poor correlation between vancomycin trough levels and clinical outcomes in the therapy of S. aureus infections. 14 The AUC/MIC pharmacodynamic index is best predictive of vancomycin efficacy, [15][16][17] and trough e8…”

Section: Discussionmentioning

confidence: 99%

The Impact of Pediatric-Specific Vancomycin Dosing Guidelines: A Quality Improvement Initiative

Miloslavsky

Galler

Moawad³

et al. 2017

Pediatrics

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“…However, in the UK, most therapeutic drug monitoring (TDM) guidelines continue to monitor vancomycin based on peak or trough concentration levels. Such monitoring has been shown to under achieve acceptable levels in clinical practice [16]. Generally, a trough level higher than 10 mg/l is expected.…”

Section: Pharmacokinetic Targetmentioning

confidence: 99%

Closed-Loop Control for Precision Antimicrobial Delivery: An <italic>In Silico</italic> Proof-of-Concept

Herrero

Rawson

Philip³

et al. 2018

IEEE Trans. Biomed. Eng.

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Abstract-Objective: Inappropriate dosing of patients with antibiotics is a driver of antimicrobial resistance, toxicity, and poor outcomes of therapy. In this paper, we investigate, in silico, the hypothesis that the use of a closed-loop control system could improve the attainment of pharmacokinetic-pharmacodynamic targets for antimicrobial therapy, where wide variations in target attainment have been reported. This includes patients in critical care, patients with renal disease and patients with obesity. Methods: The presented in silico study focuses on vancomycin delivery, a first line therapy for Methicillin-resistant Staphylococcus aureus (MRSA) that has serious side effects, including nephrotoxicity. For this purpose, an in silico platform for the simulation of pharmacokinetics of vancomycin agents was developed including 24 virtual non-critically ill adult subjects obtained from routinely collected data from two prospective audits of vancomycin therapy. Intra-day variability on renal clearance, sensor error and infusion constraints were taken into account. Proportional Integral Derivative (PID) controller was chosen because of its simplicity of implementation and satisfactory performance. Results: Even though significant intra-day variability and sensor error were considered in the simulations, by assuming a minimum inhibitory concentration of 1 mg/l for MRSA, the proposed controller was able to reach the well-established therapeutic target of 24-hour area under curve to minimum inhibitory concentration ratio equal to 400 mg · h/l for all the studied subjects, while staying significantly below toxic levels. Conclusion: A PID controller has the potential to precisely deliver a vancomycin therapy in a non-critically ill adult population. Significance: Closed-loop control for precision Vancomycin delivery can potentially reduce toxicity and poor therapeutic outcomes, as well as reduce antimicrobial resistance.

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Vancomycin Dosing Practices, Trough Concentrations, and Predicted Area Under the Curve in Children With Suspected Invasive Staphylococcal Infections

Cited by 10 publications

References 8 publications

Assessment of Initial Serum Vancomycin Trough Concentrations and Their Association with Initial Empirical Weight-Based Vancomycin Dosing and Development of Nephrotoxicity in Children: A Multicenter Retrospective Study

Assessment of Initial Serum Vancomycin Trough Concentrations and Their Association with Initial Empirical Weight-Based Vancomycin Dosing and Development of Nephrotoxicity in Children: A Multicenter Retrospective Study

The Impact of Pediatric-Specific Vancomycin Dosing Guidelines: A Quality Improvement Initiative

Closed-Loop Control for Precision Antimicrobial Delivery: An <italic>In Silico</italic> Proof-of-Concept

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