New regimen for continuous infusion of vancomycin in critically ill patients

Cristallini, Stefano, Hites, Maya, Kabtouri, Hakim, Roberts, Jason A., Beumier, Marjorie, Cotton, Frederic, Lipman, Jeffrey, Jacobs, Frederique, Vincent, Jean-Louis, Creteur, Jacques and Taccone, Fabio Silvio (2016) New regimen for continuous infusion of vancomycin in critically ill patients. Antimicrobial Agents and Chemotherapy, 60 8: 4750-4756. doi:10.1128/AAC.00330-16

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Author Cristallini, Stefano
Hites, Maya
Kabtouri, Hakim
Roberts, Jason A.
Beumier, Marjorie
Cotton, Frederic
Lipman, Jeffrey
Jacobs, Frederique
Vincent, Jean-Louis
Creteur, Jacques
Taccone, Fabio Silvio
Title New regimen for continuous infusion of vancomycin in critically ill patients
Journal name Antimicrobial Agents and Chemotherapy   Check publisher's open access policy
ISSN 1098-6596
0066-4804
Publication date 2016-08-01
Sub-type Article (original research)
DOI 10.1128/AAC.00330-16
Open Access Status File (Publisher version)
Volume 60
Issue 8
Start page 4750
End page 4756
Total pages 7
Place of publication Washington, DC, United States
Publisher American Society for Microbiology
Collection year 2017
Language eng
Abstract Despite the development of new agents with activity against Gram-positive bacteria, vancomycin remains one of the primary antibiotics for critically ill septic patients. Because sepsis can alter antimicrobial pharmacokinetics, the development of an appropriate dosing strategy to provide adequate concentrations is crucial. The aim of this study was to prospectively validate a new dosing regimen of vancomycin given by continuous infusion (CI) to septic patients. We included all adult septic patients admitted to a mixed intensive care unit (ICU) between January 2012 and May 2013, who were treated with a new vancomycin CI regimen consisting of a loading dose of 35 mg/kg of body weight given as a 4-h infusion, followed by a daily CI dose adapted to creatinine clearance (CrCL), as estimated by the Cockcroft-Gault formula (median dose, 2,112 [1,500 to 2,838] mg). Vancomycin concentrations were measured at the end of the loading dose (T1), at 12 h (T2), at 24 h (T3), and the day after the start of therapy (T4). Vancomycin concentrations of 20 to 30 mg/liter at T2, T3, and T4 were considered adequate. A total of 107 patients (72% male) were included. Median age, weight, and CrCL were 59 (interquartile range [IQR], 48 to 71) years, 75 (IQR, 65 to 85) kg, and 94 (IQR, 56 to 140) ml/min, respectively. Vancomycin concentrations were 44 (IQR, 37 to 49), 25 (IQR, 21 to 32), 22 (IQR, 19 to 28), and 26 (IQR, 22 to 29) mg/liter at T1, T2, T3, and T4, respectively. Concentrations were adequate in 56% (60/107) of patients at T2, in 54% (57/105) at T3, and in 73% (41/56) at T4. This vancomycin regimen permitted rapid attainment of target concentrations in serum for most patients. Concentrations were insufficient in only 16% of patients at 12 h of treatment.
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