Vancomycin pharmacokinetics in middle-aged and elderly men

Leonard, Ann; Boro, Maureen S.

doi:10.1093/ajhp/51.6.798

Cited by 6 publications

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“…Several investigators have reported a Cl nr representing about 30% of Cl VAN (20). However, other authors have failed to confirm this (22). In our critically ill patients, the population Cl nr represents 28% of Cl VAN using a typical value for body weight (60 kg).…”

Section: Discussionmentioning

confidence: 93%

Population pharmacokinetic parameters of vancomycin in critically ill patients

Llopis-Salvia

Jiménez-Torres

2006

J Clin Pharm Ther

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Section: Discussionmentioning

confidence: 93%

Population pharmacokinetic parameters of vancomycin in critically ill patients

Llopis-Salvia

Jiménez-Torres

2006

J Clin Pharm Ther

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“…Secondarily, we sought to classify the likely percent of steady-state achieved in order to ensure that trough concentrations were comparable. Since obtaining greater than one serum concentration after a vancomycin dose is not standard of care at the study institution, volume of distribution and vancomycin clearance were estimated based on a modification [5] of the method described by Leonard and Boro [22] using an ABW to estimate vancomycin clearance and half-life. Approximation of the percent of steady-state* achieved was calculated.…”

Section: Methodsmentioning

confidence: 99%

The association of elevated trough serum vancomycin concentrations with obesity

Richardson¹,

Scheetz²,

O'Donnell³

2015

Journal of Infection and Chemotherapy

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Background Obese patients display differences in vancomycin drug disposition, which may complicate attainment of appropriate serum vancomycin concentrations (SVCs). This study was conducted to determine if obesity leads to trough SVCs above the therapeutic range. Methods This retrospective cohort study sought to determine the rate and predictors of high (i.e. > 20 mg/L) serum trough levels according to level of obesity. Results Increasing BMI predicted SVCs > 20 mg/L after controlling for dose, age, and serum creatinine. Obese patients had significantly higher mean trough SVCs compared to non-obese patients (16.5 mg/L vs 12.1 mg/L, p=0.004) and a significantly higher proportion of obese patients had trough SVCs > 20 mg/L (18.9% vs 4.2%, p=0.03). Conclusion Increasing obesity predicted higher probabilities of SVCs > 20 mg/L. Development of alternative dosing and management strategies for vancomycin may be necessary to account for pharmacokinetic changes associated with obesity.

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“…20 Patientspecific vancomycin V d and Cl vanco were determined from the measured SVCs using the method of Sawchuk et al 21 Although vancomycin is more accurately described by a two-compartment model, a one-compartment model was used, as is frequently done in clinical practice. 1,13,19 For the various dosing methods, patient demographic data and estimated Cl cr were used to predict V d and Cl vanco and to calculate the initial dosage regimens recommended by each method. The procedure used to determine the dose and dosing interval is outlined below for each method.…”

Section: Methodsmentioning

confidence: 99%

“…[6][7][8][9][10][11] Despite the decreased emphasis on routine SVC monitoring, sufficient data remain to support individualizing vancomycin doses based on various patientspecific parameters. [12][13][14][15] Vancomycin exhibits concentration-independent killing; thus, achieving and maintaining therapeutic plasma concentrations is inherently optimal. Since most susceptible organisms have minimum inhibitory concentrations (MICs) of 2 mg/L or less and toxicity is rarely seen with trough SVCs of 20 mg/L or less, it has been suggested that maintaining trough SVCs between 5 and 20 mg/L is adequate.…”

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confidence: 99%

Clinical Application and Evaluation of Vancomycin Dosing in Adults

Rushing

Ambrose

2001

Journal of Pharmacy Technology

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Objective: To evaluate the accuracy of a vancomycin dosing method (study method) in estimating volume of distribution (V d ) and clearance of vancomycin (Cl vanco ) and the frequency with which it would provide serum vancomycin concentrations (SVCs) within a specified range compared with other published methods.Methods: One hundred and seven patients with 108 pairs of SVCs were used to calculate patient-specific V d and Cl vanco . Based on these patient-specific V d and Cl vanco values, the predictive ability of the estimated parameters from the study dosing method (V d [L] = 0.17 [age] + 0.22 [actual body weight] + 15; Cl vanco = creatinine clearance) was evaluated against three previously published pharmacokinetic dosing methods, using predictive performance analysis (precision and bias). Furthermore, the patient-specific pharmacokinetic parameters were used to simulate steady-state peak and trough SVCs, using first-order pharmacokinetic equations from doses derived from the study method, the three different pharmacokinetic methods, and two other published dosing schemes. The frequency with which each method would have achieved target peak and trough SVCs was determined. Results:The study method was found to be more precise and less biased (p < 0.05) than comparative methods in predicting vancomycin V d and Cl vanco . The study method also resulted in a higher frequency of steady-state peak and trough SVCs within the target range specified. Conclusions:The study method presented here provided a reliable estimation of vancomycin pharmacokinetic parameters that was easily applied to various patient populations to individualize vancomycin dosing, and frequently yielded SVCs within a predictable and desired range.

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Vancomycin pharmacokinetics in middle-aged and elderly men

Cited by 6 publications

References 0 publications

Population pharmacokinetic parameters of vancomycin in critically ill patients

Population pharmacokinetic parameters of vancomycin in critically ill patients

The association of elevated trough serum vancomycin concentrations with obesity

Clinical Application and Evaluation of Vancomycin Dosing in Adults

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