A simulation of loading doses for vancomycin continuous infusion regimens in intensive care
Martin Šíma1, Karolína Hronová1, Jan Hartinger1
1a Department of Pharmacology, First Faculty of Medicine , Charles University and General University Hospital in Prague , Prague , Czech Republic.
Infectious Diseases (London, England)
|May 16, 2017
Summary
Total body weight best predicts vancomycin volume of distribution. An optimal loading dose (LD) of 10.7 mg/kg TBW significantly reduces time to therapeutic vancomycin serum concentrations.
Area of Science:
- Pharmacokinetics
- Clinical Pharmacy
- Drug Dosing
Background:
- Delayed achievement of target vancomycin serum concentrations impacts clinical outcomes.
- Accurate prediction of vancomycin volume of distribution is crucial for effective dosing.
Purpose of the Study:
- Compare prediction accuracy of body weight descriptors for vancomycin volume of distribution.
- Propose an optimal vancomycin loading dose (LD) for continuous infusion in adults.
Main Methods:
- Retrospective study of 30 adult patients.
- One-compartmental pharmacokinetic analysis to compute vancomycin variables.
- Simulated vancomycin LDs evaluated using different body weight descriptors.
Main Results:
- Total body weight (TBW) demonstrated superior prediction accuracy for vancomycin volume of distribution compared to ideal or adjusted body weight.
- Median vancomycin volume of distribution, clearance, and half-life were 0.45 L/kg, 0.026 L/h/kg, and 10.3 h, respectively.
Conclusions:
- An optimal vancomycin LD of 10.7 mg/kg TBW was identified.
- This LD minimized subtherapeutic and supratherapeutic vancomycin serum concentrations.
- Implementing this LD reduced median time to reach target concentrations from 17 to 1 hour.
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