Vancomycin population pharmacokinetics for adult patients with sepsis or septic shock: are current dosing regimens sufficient?
Purpose: Vancomycin is commonly used for the management of severe infections; however, vancomycin dosing may be challenging in critically ill patients. This observational study aims to describe the population pharmacokinetics of vancomycin in adult patients with sepsis or septic shock. Methods: A si...
| Published in: | European Journal of Clinical Pharmacology Vol. 75; no. 9; pp. 1219 - 1227 |
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| Main Authors: | , , , , |
| Format: | equations & formulas research tables/charts Journal Article |
| Published: |
Springer Nature
Sep2019
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| Online Access: | View this record in EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=138111093&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 138111093 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 00316970 NP9 jtl: European Journal of Clinical Pharmacology issn: 00316970 maglogo: N pubinfo: dt: Sep2019 vid: 75 iid: 9 pid: 237 pub: Springer Nature place: New York, New York artinfo: ui: 138111093 138111093 144143259 138111093 10.1007/s00228-019-02694-1 138111093 ppf: 1219 ppct: 8 formats: fmt: – @attributes: type: T – @attributes: type: P tig: atl: Vancomycin population pharmacokinetics for adult patients with sepsis or septic shock: are current dosing regimens sufficient? aug: au: Heffernan, A. J. Germano, A. Sime, F. B. Roberts, Jason A. Kimura, E. affil: Centre for Translational Anti-Infective Pharmacodynamics, School of Pharmacy, The University of Queensland, Brisbane, Queensland, Australia sug: subj: Vancomycin Pharmacokinetics Sepsis Drug Therapy Human Shock, Septic Drug Therapy Nonexperimental Studies Retrospective Design Drug Monitoring Blood Specimen Collection Vancomycin Administration and Dosage Intensive Care Units Creatinine Body Surface Area Computer Simulation Adult Systems Analysis Critically Ill Patients Dosage Calculation Models, Statistical Adult: 19-44 years ab: Purpose: Vancomycin is commonly used for the management of severe infections; however, vancomycin dosing may be challenging in critically ill patients. This observational study aims to describe the population pharmacokinetics of vancomycin in adult patients with sepsis or septic shock. Methods: A single-centre retrospective review of adult patients with sepsis or septic shock receiving vancomycin with therapeutic drug monitoring was undertaken. Blood samples taken 1 h after the vancomycin infusion cessation and 30 min prior to the next dose were assayed using the Vitros Crea Slide method. Vancomycin concentrations determined on different days were included. A pharmacokinetic model was developed using Pmetrics for R. Monte Carlo dosing simulations were performed using the final model. Results: Vancomycin concentrations were available for 27 adult patients admitted to the intensive care unit with sepsis or septic shock. A one-compartment pharmacokinetic model with inter-occasion variability of clearance and volume of distribution before and after 72 h adequately described the data. Creatinine clearance normalized to body surface area was included as a covariate on vancomycin clearance. The clearance and volume of distribution within 72 h of admission were 7.29 L/h and 54.20 L, respectively. Monte Carlo simulations suggested that for patients with a creatinine clearance of ≥ 80 mL/min/1.73 m2, vancomycin doses of ≥ 2 g every 8 h are required to consistently achieve key therapeutic targets. Conclusions: Vancomycin doses ≥ 2 g every 8 h in adult patients with sepsis or septic shock with a creatinine clearance ≥ 80 mL/min/1.73 m2 are likely needed to achieve an optimal therapeutic exposure. pubtype: Academic Journal doctype: equations & formulas research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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