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Elevations of urinary pH may lower vancomycin serum concentration.

Yoichi Hiraki1, Yasuhiro Tsuji, Naoko Yasumori

  • 1Department of Pharmacy, National Hospital Organization Beppu Medical Center, Oita, Department of Pharmacy, Department of Hematology, National Hospital Organization Kumamoto Medical Center, Kumamoto, Graduate School of Medicine and Pharmaceutical Sciences for Research, University of Toyama, Toyama, and Faculty of Pharmaceutical Sciences, Fukuoka University, Fukuoka, Japan.

International Journal of Clinical Pharmacology and Therapeutics
|November 13, 2015
PubMed
Summary

Elevated urinary pH increases vancomycin (VCM) elimination in patients with methicillin-resistant Staphylococcus aureus (MRSA) pneumonia. Monitoring urinary pH is crucial for optimizing VCM dosing and ensuring effective treatment.

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Area of Science:

  • Pharmacokinetics
  • Infectious Diseases
  • Nephrology

Background:

  • Vancomycin (VCM) is a critical antibiotic for treating methicillin-resistant Staphylococcus aureus (MRSA) infections.
  • Understanding factors influencing VCM elimination is essential for effective therapeutic drug monitoring.

Purpose of the Study:

  • To investigate endogenous factors affecting vancomycin (VCM) elimination in adult MRSA pneumonia patients.
  • To identify clinical parameters that may increase VCM clearance.

Main Methods:

  • Retrospective evaluation of 48 MRSA pneumonia patients receiving intravenous VCM.
  • Analysis of patient data including demographics, VCM dosage, and laboratory values.
  • Statistical analysis (univariate and multivariate) to identify risk factors for VCM clearance.

Main Results:

  • Urinary pH was identified as an independent risk factor for VCM clearance.
  • Higher urinary pH (alkalinity) was associated with significantly increased VCM clearance.
  • VCM clearance was notably higher in patients with urinary pH of 8 compared to pH 5.

Conclusions:

  • Increased urinary pH promotes the urinary excretion of vancomycin (VCM).
  • This effect is likely due to enhanced dissociation of VCM's carboxyl group at higher pH.
  • Clinical monitoring of urinary pH is recommended for adjusting VCM dosage to maintain therapeutic concentrations.