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[Dosage adjustment of vancomycin in continuous infusion in critically ill-patients]

A Carricajo1, A Forgeot, J Morel

  • 1Laboratoire de bactériologie-virologie, CHU de Saint-Etienne, avenue A.-Raimond, 42277 Saint-Priest-en-Jarez, France.

Annales Francaises D'Anesthesie Et De Reanimation
|January 16, 2010
PubMed
Abstract

Insights

Rising staphylococcal resistance necessitates higher vancomycin doses. Continuous infusion with a loading dose and 24-hour maintenance dose requires serum vancomycin monitoring for optimal therapeutic efficacy and to prevent toxicity.

Area of Science:

  • Pharmacology
  • Infectious Diseases
  • Critical Care Medicine

Context:

  • Increasing resistance of staphylococcal strains to glycopeptides necessitates higher vancomycin dosages.
  • Vancomycin is a critical antibiotic for treating serious Gram-positive bacterial infections.
  • Optimizing vancomycin dosing is crucial in intensive care settings.

Purpose:

  • To evaluate a vancomycin administration protocol using continuous infusion.
  • The protocol involved a loading dose of 30 mg/kg followed by 30 mg/kg per 24 hours.
  • This evaluation focused on intensive care patients with creatinine clearance (CLc) greater than 50 mL/min.

Summary:

  • Twenty-two patients were studied. Serum vancomycin concentrations (C24h) varied based on CLc.
  • In patients with CLc < 120 mL/min, C24h ranged from 25-30 mg/L in 50%, with some exceeding 35 mg/L or falling below 25 mg/L.
  • Patients with CLc ≥ 120 mL/min had C24h < 20 mg/L. For those with CLc < 120 mL/min, C24h/MIC ≥ 8 and AUC/MIC ≥ 350 were observed in a subset.

Impact:

  • Serum vancomycin concentration monitoring is essential post-administration.
  • This monitoring allows for rapid adjustments to improve therapeutic efficacy.
  • Monitoring helps in avoiding vancomycin-induced nephrotoxicity.

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