A new regimen for continuous infusion of vancomycin during continuous renal replacement therapy
Marjorie Beumier1, Jason A Roberts, Hakim Kabtouri
1Department of Intensive Care, Hôpital Erasme, Université Libre de Bruxelles, Route de Lennik, 808, 1070 Bruxelles, Belgium.
The Journal of Antimicrobial Chemotherapy
|June 27, 2013
Summary
This study evaluated a new continuous infusion vancomycin regimen in patients on continuous renal replacement therapy (CRRT). The regimen achieved adequate vancomycin concentrations in most patients, with CRRT intensity influencing drug clearance.
Area of Science:
- Pharmacology
- Nephrology
- Infectious Diseases
Background:
- Continuous infusion (CI) vancomycin is crucial for treating severe Gram-positive infections.
- Its use in patients undergoing continuous renal replacement therapy (CRRT) is not well-established.
- This study addresses the need for optimized vancomycin dosing in CRRT patients.
Purpose of the Study:
- To assess the adequacy of a novel CI vancomycin regimen in septic patients receiving CRRT.
- To determine if the new regimen rapidly achieves target vancomycin concentrations.
- To identify factors influencing vancomycin levels during CRRT.
Main Methods:
- Prospective study measuring vancomycin concentrations with a CI regimen (35 mg/kg loading dose, 14 mg/kg daily dose).
- Vancomycin levels monitored at 3 time points: end of loading dose (T1), 12 hours (T2), and 24 hours (T3).
- Adequate concentrations defined as 20-30 mg/L at T2 and T3; CRRT intensity calculated; population pharmacokinetics analyzed.
Main Results:
- 32 patients studied; median loading dose 2750 mg, daily dose 1100 mg.
- Median vancomycin concentrations: T1=44 mg/L, T2=27 mg/L, T3=23 mg/L.
- Adequate concentrations achieved in 69% at T2 and 63% at T3; body weight and CRRT intensity were significant covariates.
Conclusions:
- The new CI vancomycin regimen effectively achieved target concentrations in most CRRT patients.
- CRRT intensity significantly impacts vancomycin clearance.
- This regimen offers a promising approach for vancomycin therapy in critically ill patients with renal replacement therapy.
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