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Vancomycin clearance in high-volume venovenous hemofiltration.
Christopher A Paciullo1, Kevin C Harned, George A Davis
1Department of Pharmaceutical Services, Emory University Hospital, Atlanta, GA, USA. Christopher.paciullo@emoryhealthcare.org
The Annals of Pharmacotherapy
|February 14, 2013
Summary
Vancomycin clearance varies greatly in patients on high-volume continuous venovenous hemofiltration (CVVH). Standard dosing may result in subtherapeutic levels, necessitating individualized vancomycin treatment plans.
Area of Science:
- Pharmacology
- Nephrology
- Critical Care Medicine
Background:
- Continuous venovenous hemofiltration (CVVH) is used for acute renal failure.
- Vancomycin is an antibiotic often used in critically ill patients.
Observation:
- This study examined vancomycin pharmacokinetics in 4 patients on high-volume CVVH.
- Vancomycin levels were measured at 4 and 24 hours post-infusion.
- High-volume CVVH fluid rates averaged 56.2 mL/kg/h.
Findings:
- Significant variability in vancomycin clearance was observed.
- Median vancomycin concentration at 4 hours was 18.1 mg/L.
- Only one patient had detectable vancomycin at 24 hours (5.2 mg/L).
Implications:
- Current vancomycin dosing strategies may lead to subtherapeutic concentrations in CVVH patients.
- Dosing should be tailored based on CVVH prescription, drug levels, and clinical response.
- An initial dose of 20-25 mg/kg with frequent monitoring is recommended.
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