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A simple method for administering vancomycin in the spinal cord injured population
A R Griver1, R A Prince, R O Darouiche
1Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA.
Objective:
To examine the applicability in patients with spinal cord injury (SCI) of a modified version of the commonly used Lake and Peterson dosing regimen for vancomycin.
Design:
Nonrandomized, prospective clinical trial with a historical control.
Setting:
Spinal cord injury unit at a Veterans Affairs Medical Center.
Patients:
Hospitalized patients with a history of SCI at least 6 months earlier and an estimated creatinine clearance of > or = 15 mL/min who required vancomycin therapy. The experimental group consisted of 15 evaluable patients, 8 with tetraplegia and 7 with paraplegia.
Intervention:
Vancomycin regimens were initiated using a modified version of the guidelines of Lake and Peterson.
Main Outcome Measure:
After 4 to 8 doses, peak vancomycin concentrations in serum were obtained 15 minutes after a 1-hour infusion, and trough concentrations were drawn within 30 minutes of the next scheduled dose.
Results:
Only 3 of 15 (20%) patients in the experimental group required a single adjustment in the dosing interval to achieve the targeted serum vancomycin concentrations. The proportion of patients who required dosing modification was significantly lower in the experimental group than in a group of 16 SCI control patients who received vancomycin according to the dosing recommendations in the drug insert (20% vs 75%, respectively; p = .002).
Conclusion:
These results support the need for tailored vancomycin dosing in the SCI population and the efficacy of this simple method of administering vancomycin in achieving desirable concentrations of vancomycin in the serum of SCI patients.