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Vancomycin dosing for pneumonia in critically ill trauma patients
Asad E Patanwala1, Christopher J Norris, David E Nix
1Department of Pharmacy Practice and Science, The University of Arizona College of Pharmacy, Tucson, Arizona 85721-0207, USA.
The Journal of Trauma
|October 13, 2009
Summary
For methicillin-resistant Staphylococcus aureus (MRSA) pneumonia, a vancomycin dose of 1 gram every 12 hours is insufficient for critically ill trauma patients. Higher doses, such as 1 gram every 8 hours, are necessary to reach therapeutic vancomycin trough concentrations.
Area of Science:
- Pharmacology and Critical Care Medicine
- Infectious Diseases and Trauma Surgery
Background:
- Vancomycin is the recommended treatment for methicillin-resistant Staphylococcus aureus (MRSA) pneumonia.
- Therapeutic vancomycin trough concentrations are targeted between 15 to 20 mg/L.
- Optimal vancomycin dosing in critically ill trauma patients with MRSA pneumonia requires evaluation.
Purpose of the Study:
- To assess the initial vancomycin dosing regimens in critically ill adult trauma patients diagnosed with MRSA pneumonia.
- To compare the efficacy of two vancomycin dosing schedules: 1 gram intravenously (i.v.) every 8 hours versus 1 gram i.v. every 12 hours.
Main Methods:
- Retrospective study of critically ill adult trauma patients with MRSA pneumonia.
- Comparison of steady-state vancomycin trough concentrations between patients receiving 1 g i.v. every 8 hours and those receiving 1 g i.v. every 12 hours.
- Statistical analysis using Student's t test (alpha = 0.05) to compare demographic variables and trough concentrations.
Main Results:
- 36 patients were included: 17 in the every 8-hour group and 19 in the every 12-hour group.
- The mean steady-state vancomycin trough concentration was significantly higher in the 1 g every 8-hour group (11.1 mg/L) compared to the 1 g every 12-hour group (6.8 mg/L) (p = 0.014).
- Therapeutic trough concentrations (>15 mg/L) were achieved in 23.5% of patients on the every 8-hour regimen, versus 0% on the every 12-hour regimen.
Conclusions:
- A vancomycin regimen of 1 g i.v. every 12 hours is insufficient to achieve target trough concentrations (15-20 mg/L) in critically ill trauma patients with MRSA pneumonia and normal renal function.
- Dosing vancomycin at 1 g i.v. every 8 hours is necessary to increase the likelihood of achieving therapeutic trough concentrations in this patient population.
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