Evaluation of a protocol for vancomycin administration in critically patients with and without kidney dysfunction

Area of Science:

• Pharmacology
• Nephrology
• Critical Care Medicine

Background:

• Vancomycin dosing requires careful management in critically ill patients to prevent subtherapeutic levels (linked to mortality) and accumulation (linked to nephrotoxicity).
• Optimizing vancomycin serum concentration (VSC) is essential for efficacy and safety in intensive care settings.

Purpose of the Study:

• To evaluate the effectiveness of a vancomycin dosing protocol in achieving therapeutic serum concentrations in critically ill patients with varying degrees of kidney function.
• To compare VSC outcomes between patients with normal kidney function and those with kidney dysfunction.

Main Methods:

• Retrospective analysis of critically ill patients receiving continuous infusion vancomycin.
• Comparison of two groups: Group A (creatinative clearance > 50 ml/min) and Group B (creatinative clearance ≤ 50 ml/min).

Main Results:

• Patients with kidney dysfunction (Group B) showed a higher initial percentage of VSC within the target range.
• Low vancomycin concentrations decreased over time, except in patients with augmented renal clearance.
• Approximately 28% of patients had VSC > 30 mg/L, regardless of kidney function.
• Subtherapeutic VSC at the first measurement correlated significantly with in-hospital mortality.

Conclusions:

• The vancomycin dosing protocol facilitates rapid achievement of target VSC, particularly in patients with impaired kidney function.
• Incorporating augmented renal clearance assessment into the protocol is recommended to prevent subtherapeutic vancomycin levels.