Vancomycin dosing nomograms targeting high serum trough levels in different populations: pros and cons.

Purpose: Utilization of higher doses of vancomycin to achieve the trough concentrations of 15-20 mg/L for complicated infections has been recommended by the Infectious Diseases Society of America clinical practice guideline in recent years. Concerning this recommendation, several nomograms have been...

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Publicado en:European Journal of Clinical Pharmacology Vol. 72; no. 7; pp. 777 - 789
Autores principales: Elyasi, Sepideh, Khalili, Hossein
Formato: review tables/charts Journal Article
Publicado: Springer Nature Jul2016
Acceso en línea:Ver este registro en EBSCOhost
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      dt: Jul2016
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      pub: Springer Nature
      place: New York, New York
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        10.1007/s00228-016-2063-8
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        atl: Vancomycin dosing nomograms targeting high serum trough levels in different populations: pros and cons.
      aug:
        au:
          Elyasi, Sepideh
          Khalili, Hossein
        affil: Department of Clinical Pharmacy, Faculty of Pharmacy, Mashhad University of Medical Sciences, Mashhad Iran
      sug:
        subj:
          Vancomycin Administration and Dosage
          Dose-Response Relationship, Drug
          Models, Statistical Methods
          Body Weight
          Kidney Physiology
          Hemodialysis
          Validation Studies
          Vancomycin Blood
      ab: Purpose: Utilization of higher doses of vancomycin to achieve the trough concentrations of 15-20 mg/L for complicated infections has been recommended by the Infectious Diseases Society of America clinical practice guideline in recent years. Concerning this recommendation, several nomograms have been constructed targeting this optimal trough level range in different populations of patients. In this review, we have collected available nomograms targeting high trough serum levels of vancomycin, particularly comparing their advantages and limitations. Method: The data were collected by searching Scopus, PubMed, Google scholar, Medline, and Cochrane database systematic reviews. The key words used as search terms were 'vancomycin', 'high trough level', 'dosing nomogram', 'dosing strategy', 'neonates', 'critically ill', 'pediatrics', and 'hemodialysis'. We have included 17 related human studies published up to the date of this publication. Results & conclusion: Most of the available nomograms have determined the doses according to body weight and renal function. Their initial predicting success rate were 44-76 % for non-critically ill patients, 42-84 % for critically ill patients, 54 % for one nomogram specially designed for hemodialysis patients, and 71 % for the only nomogram developed for neonates. Based on validation studies, in most of cases, using a vancomycin dosing nomogram significantly improved and accelerated achievement of target trough concentrations. However, it should be noted that there are limited data about patients' clinical and microbiological outcomes and they are only validated in narrow groups of patients. Thus, their widespread application could not be encouraged for all patients before performing adequately powered, prospective randomized studies.
      pubtype: Academic Journal
      doctype:
        review
        tables/charts
        Journal Article
      ougenre: Article
    language: English
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