Decreasing the time to achieve therapeutic vancomycin concentrations in critically ill patients: Developing and testing of a dosing nomogram

Baptista, Joao P., Roberts, Jason A., Sousa, Eduardo, Freitas, Ricardo, Deveza, Nuno and Pimentel, Jorge (2014) Decreasing the time to achieve therapeutic vancomycin concentrations in critically ill patients: Developing and testing of a dosing nomogram. Critical Care, 18 654: 1-9. doi:10.1186/s13054-014-0654-2


Author Baptista, Joao P.
Roberts, Jason A.
Sousa, Eduardo
Freitas, Ricardo
Deveza, Nuno
Pimentel, Jorge
Title Decreasing the time to achieve therapeutic vancomycin concentrations in critically ill patients: Developing and testing of a dosing nomogram
Journal name Critical Care   Check publisher's open access policy
ISSN 1466-609X
1364-8535
Publication date 2014-12-05
Sub-type Article (original research)
DOI 10.1186/s13054-014-0654-2
Open Access Status DOI
Volume 18
Issue 654
Start page 1
End page 9
Total pages 9
Place of publication London, England, U.K.
Publisher BioMed Central Ltd.
Collection year 2015
Language eng
Subject 2706 Critical Care and Intensive Care Medicine
Formatted abstract
Introduction
Achievement of optimal vancomycin exposure is crucial to improve the management of patients with life-threatening infections caused by susceptible Gram-positive bacteria and is of particular concern in patients with augmented renal clearance (ARC). The aim of this study was to develop a dosing nomogram for the administration of vancomycin by continuous infusion for the first 24 hours of therapy based on the measured urinary creatinine clearance (8 h CLCR).

Methods
This single-center study included all critically ill patients treated with vancomycin over a 13-month period (group 1), in which we retrospectively assessed the correlation between vancomycin clearance and 8 h CLCR. This data was used to develop a formula for optimised drug dosing. The efficiency of this formula was prospectively evaluated in a second cohort of 25 consecutive critically ill patients (group 2). Vancomycin serum concentrations between 20 to 30 mg/L were considered adequate. ARC was defined as 8 h CLCR more than 130 ml/min/1.73 m2.

Results
The incidence of ARC was 36% (n = 29/79) and 40% (10/25) in group 1 (n = 79) and 2 (n = 25), respectively. The mean serum vancomycin concentration on day 1 was 21.5 (6.4) and 24.5 (5.2) mg/L, for both groups respectively. On the treatment day, vancomycin plasma clearance was 5.12 (1.9) L/h in group 1 and correlated significantly with the 8 h CLCR (r2 = 0.66; P <0.001). The achievement of adequate vancomycin serum concentrations in group 2 was 84% (n = 21/25) versus 51% (n = 40/79) – P <0.005.

Conclusions
This new vancomycin nomogram enabled the achievement of adequate serum concentrations in 84% of the patients on the first day of treatment.
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2015 Collection
School of Medicine Publications
 
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