A new regimen for continuous infusion of vancomycin during continuous renal replacement therapy

Beumier, Marjorie, Roberts, Jason A., Kabtouri, Hakim, Hites, Maya, Cotton, Frederic, Wolff, Fleur, Lipman, Jeffrey, Jacobs, Frederique, Vincent, Jean-Louis and Taccone, Fabio Silvio (2013) A new regimen for continuous infusion of vancomycin during continuous renal replacement therapy. Journal of Antimicrobial Chemotherapy, 68 12: 2859-2865. doi:10.1093/jac/dkt261


Author Beumier, Marjorie
Roberts, Jason A.
Kabtouri, Hakim
Hites, Maya
Cotton, Frederic
Wolff, Fleur
Lipman, Jeffrey
Jacobs, Frederique
Vincent, Jean-Louis
Taccone, Fabio Silvio
Title A new regimen for continuous infusion of vancomycin during continuous renal replacement therapy
Journal name Journal of Antimicrobial Chemotherapy   Check publisher's open access policy
ISSN 0305-7453
1460-2091
Publication date 2013-01-01
Year available 2013
Sub-type Article (original research)
DOI 10.1093/jac/dkt261
Open Access Status DOI
Volume 68
Issue 12
Start page 2859
End page 2865
Total pages 7
Place of publication Oxford, United Kingdom
Publisher Oxford University Press
Language eng
Subject 3004 Pharmacology
2736 Pharmacology (medical)
2725 Infectious Diseases
Abstract Introduction: Continuous infusion (CI) of high-dose vancomycin is often used to treat life-threatening infections caused by less-susceptible Gram-positive bacteria. However, this approach has not been well studied in patients on continuous renal replacement therapy (CRRT). The aim of this study was to evaluate the adequacy of a new CI vancomycin regimen in septic patients undergoing CRRT. Methods: In this prospective study we measured vancomycin concentrations obtained with a new CI regimen for CRRT, which included a loading dose of 35 mg/kg given over a 4 h period followed by a daily dose of 14 mg/kg. Vancomycin concentrations were measured: at the end of the loading dose (T1); 12 h after the onset of therapy (T2); and 24 h after the onset of therapy (T3). Drug concentrations (at T2 and T3) were considered adequate if between 20 and 30 mg/L. CRRT intensity was calculated as: dialysate rate (mL/kg/h)+ultrafiltration rate (mL/kg/h). Vancomycin population pharmacokinetics were calculated using non-linear mixed-effects modelling. Results: We studied 32 patients who received median (IQR) loading and daily vancomycin doses of 2750 mg (2250-3150) and 1100 mg (975-1270), respectively. Drug concentrations were: T1, 44 mg/L (38-58); T2, 27 mg/L (24-31); and T3, 23 mg/L (19-31). Vancomycin concentrations were adequate in 22/32 patients (69%) at T2 and in 20/32 (63%) at T3. The two relevant covariates that significantly affected drug concentrations were body weight and CRRT intensity. Conclusions: This new vancomycin regimen allowed the rapid achievement of target drug concentrations in the majority of patients. CRRT intensity had an influence on vancomycin clearance.
Keyword Loading dose
Pharmacokinetics
Sepsis
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2014 Collection
School of Medicine Publications
 
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