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Performance of a divided-load intravenous vancomycin dosing strategy for obese patients

Tina Harrach Denetclaw1, Mark Kevin Yu2, Mee Moua2

  • 1Marin General Hospital, Greenbrae, CA, USA University of California, San Francisco, CA, USA denetclawt@pharmacy.ucsf.edu.

The Annals of Pharmacotherapy
|May 20, 2015
PubMed
Abstract

Insights

A new vancomycin dosing protocol for obese patients effectively achieved target therapeutic trough concentrations rapidly and safely. This obese-specific, divided-load method ensures optimal vancomycin levels, preventing resistance and supratherapeutic levels.

Area of Science:

  • Pharmacology
  • Infectious Diseases
  • Clinical Pharmacy

Background:

  • Current guidelines recommend vancomycin trough concentrations of 15-20 µg/mL for complicated infections.
  • Achieving these targets in obese patients has been challenging with existing protocols.
  • Preventing antimicrobial resistance necessitates maintaining therapeutic vancomycin levels.

Purpose of the Study:

  • To assess a novel, obese-specific, divided-load vancomycin protocol.
  • To evaluate the protocol's efficacy in achieving target trough concentrations within 12-24 hours.
  • To determine if the protocol maintains therapeutic levels during maintenance dosing in obese patients.

Main Methods:

  • Prospective medical record review of 54 consecutive obese patients.
  • Vancomycin serum concentrations monitored before the third and fifth doses.
  • Steady-state concentrations assessed after the third dose and periodically thereafter.

Main Results:

  • 89% of patients achieved target trough concentrations (10-20 µg/mL) within 12 hours.
  • 94% of patients had trough concentrations >10 µg/mL within 12 hours.
  • 97% of troughs during maintenance dosing were within the target range.

Conclusions:

  • The obese-specific, divided-load vancomycin protocol successfully achieved target trough concentrations in most obese patients.
  • The protocol demonstrated effectiveness within 12-24 hours of initial dosing.
  • This method prevented supratherapeutic levels and maintained therapeutic concentrations during steady-state dosing.
Keywords:
drug concentrationobesitytreatment protocolvancomycin

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