Vancomycin clearance during continuous venovenous haemofiltration in critically ill patients
Weerachai Chaijamorn1, Arnurai Jitsurong, Kamonthip Wiwattanawongsa
1Faculty of Pharmacy, Siam University, Bangkok 10160, Thailand. zernpharm@yahoo.com
International Journal of Antimicrobial Agents
|June 4, 2011
Summary
Continuous venovenous haemofiltration (CVVH) removes about half of vancomycin in critically ill patients. Dosing adjustments are crucial, with 500-750 mg every 12 hours recommended, alongside close monitoring of vancomycin levels.
Area of Science:
- Pharmacology
- Nephrology
- Critical Care Medicine
Background:
- Vancomycin is a critical antibiotic for severe infections.
- Continuous venovenous haemofiltration (CVVH) is frequently used in critically ill patients.
- Optimizing vancomycin dosing during CVVH is essential for therapeutic efficacy and safety.
Purpose of the Study:
- To determine the pharmacokinetics of vancomycin in critically ill patients undergoing CVVH.
- To establish evidence-based vancomycin dosing recommendations for patients on CVVH.
- To quantify the contribution of CVVH to vancomycin clearance.
Main Methods:
- Prospective study in an Intensive Care Unit involving seven critically ill patients.
- Vancomycin pharmacokinetics assessed via serum and ultrafiltrate sampling over 12 hours post-infusion.
- CVVH performed using a triacetate hollow-fibre dialyser in pre-dilution mode.
Main Results:
- Vancomycin sieving coefficient was 0.71±0.13, indicating significant removal by CVVH.
- CVVH accounted for approximately 49.4% of total vancomycin clearance.
- Estimated vancomycin dose removal by CVVH was 213.9±104.0 mg over 12 hours.
- Volume of distribution was smaller than previously reported (24.69±11.00 L).
Conclusions:
- CVVH significantly contributes to vancomycin elimination in critically ill patients.
- Recommended vancomycin maintenance dose is 500-750 mg every 12 hours for target trough concentrations of 15-20 mg/L.
- Close monitoring of serum vancomycin concentrations is imperative due to altered pharmacokinetics during CVVH.
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