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High-throughput Fluorometric Measurement of Potential Soil Extracellular Enzyme Activities
Published on: November 15, 2013
[Not Available]
Mohamed Larbi Jelassi1, Amine Benlmouden1, Sandrine Lefeuvre2
1Pharmacologie, AP-HP, Hôpital Européen Georges Pompidou, Paris, France.
Abstract:
Level of Evidence for Therapeutic Drug Monitoring of Vancomycin. Vancomycin is an antibiotic for exclusive hospital use administrated in intravenous infusion to treat systemic infections. It is mainly eliminated by kidneys and potentially nephrotoxic. Data available show that Therapeutic Drug Monitoring (TDM) of vancomycin is highly recommended. It aims to ensure efficacy and avoid resistance by maintaining trough plasma concentrations above the MIC. Secondary, vancomycine TDM may be indicated to prevent nephrotoxicity in high risk patients. TDM is often underwent at steady state (48 to 72 h after the treatment initiation) unless in case of renal impairment (24 h). While compared with intermittent administration, continuous infusion did not result in prognosis improvement; however it resulted in lower pharmacokinetic variability and better cost-efficiency. Targeted trough concentrations for intermittent infusion are between 15 and 20 mg/L (up to 25-30 mg/L for GISA). In case of continuous infusion, targets are higher (25 to 40 mg/L).
Insights
Therapeutic Drug Monitoring (TDM) of vancomycin is crucial for ensuring treatment efficacy and preventing kidney damage. This antibiotic monitoring helps maintain optimal drug levels, reducing resistance and toxicity risks in hospitalized patients.
Area of Science:
- Pharmacology
- Infectious Diseases
- Nephrology
Context:
- Vancomycin is a critical intravenous antibiotic for severe hospital-acquired infections.
- Its renal elimination and potential nephrotoxicity necessitate careful dosing.
- Current data strongly support the use of vancomycin Therapeutic Drug Monitoring (TDM).
Purpose:
- To optimize vancomycin efficacy by maintaining trough concentrations above the minimum inhibitory concentration (MIC).
- To minimize the risk of vancomycin-induced nephrotoxicity, especially in high-risk patient populations.
- To guide vancomycin dosing strategies for both intermittent and continuous infusion methods.
Summary:
- TDM is recommended to ensure vancomycin effectiveness and prevent antibiotic resistance.
- Monitoring helps mitigate nephrotoxicity in vulnerable patients.
- Recommended trough concentrations differ for intermittent (15-20 mg/L) versus continuous (25-40 mg/L) infusions, with specific targets for GISA infections.
Impact:
- Optimized vancomycin TDM can lead to improved patient outcomes and reduced healthcare costs.
- Consistent monitoring aids in preventing the development of vancomycin resistance.
- Tailored dosing based on TDM minimizes adverse events like nephrotoxicity.
