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Published on: March 3, 2023
Comparing two predictive methods for determining serum vancomycin concentrations at a Veterans Affairs Medical Center
Elena Lee1, Michael E Winter, Maureen S Boro
1Kaiser Foundation Hospitals, Richmond Medical Center, CA, USA.
Summary
Two methods for predicting serum vancomycin concentrations (SVCs) showed similar overall accuracy in veterans. The Leonard and Boro method was better for patients near ideal body weight, while Rushing and Ambrose suited heavier patients.
Area of Science:
- Pharmacokinetics and Drug Monitoring
- Clinical Pharmacy Practice
- Therapeutic Drug Monitoring
Background:
- Accurate prediction of serum vancomycin concentrations (SVCs) is crucial for optimizing therapy and minimizing toxicity.
- Existing predictive methods vary in their performance across different patient populations.
- Veterans Affairs medical centers require reliable methods for vancomycin dosing.
Purpose of the Study:
- To compare the predictive accuracy of two distinct methods for determining SVCs.
- To evaluate the performance of the Leonard and Boro method versus the Rushing and Ambrose method.
- To identify which method is more suitable for predicting SVCs in a veteran patient population.
Main Methods:
- Retrospective analysis of inpatient data from San Francisco Veterans Affairs Medical Center (2003).
- Inclusion of patients receiving intravenous vancomycin with recorded concentrations.
- Estimation of creatinine clearance using the Cockcroft and Gault equation and calculation of volume of distribution for each method.
Main Results:
- No significant overall difference in precision or bias between the Leonard and Boro and Rushing and Ambrose methods.
- The Leonard and Boro method demonstrated higher precision and lower bias in patients within 120% of ideal body weight (IBW).
- The Rushing and Ambrose method showed less bias and a trend towards higher precision in patients exceeding 120% of IBW.
Conclusions:
- Both predictive methods offer comparable SVC predictability in a veteran population.
- The Leonard and Boro method is superior for patients closer to their IBW.
- The Rushing and Ambrose method may be more appropriate for patients with higher body weights.
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