New Regimen for Continuous Infusion of Vancomycin in Critically Ill Patients
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| Název: | New Regimen for Continuous Infusion of Vancomycin in Critically Ill Patients |
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| Autoři: | Cristallini, Stefano, Creteur, Jacques, Taccone, Fabio, Hites, Maya, Kabtouri, Hakim, Roberts, Jason A, Beumier, Marjorie, Cotton, Frédéric, Lipman, Jeffrey, Jacobs, Frédérique, Vincent, Jean Louis |
| Zdroj: | Antimicrobial Agents and Chemotherapy. 60:4750-4756 |
| Informace o vydavateli: | American Society for Microbiology, 2016. |
| Rok vydání: | 2016 |
| Témata: | Male, 0301 basic medicine, Infusions, Obese-Patients, Critical Illness, Intravenous -- methods, Sepsis -- drug therapy, Pharmacologie, Anti-Bacterial Agents -- administration & dosage, 03 medical and health sciences, Plasma Creatinine, Intensive-Care-Unit, Vancomycin, Sepsis, 2736 Pharmacology (medical), Humans, Pathologie maladies infectieuses, Infusions, Intravenous, Aged, 0303 health sciences, Vancomycin -- administration & dosage, Pharmacodynamic Properties, Augmented Renal Clearance, 2725 Infectious Diseases, Middle Aged, Creatinine Clearance, Anti-Bacterial Agents, 3. Good health, Intensive Care Units, 3004 Pharmacology, Gram-Positive Infections, Female, Therapy, Intermittent Infusion, Septic Patients |
| Popis: | Despite the development of new agents with activity against Gram-positive bacteria, vancomycin remains one of the primary antibiotics for critically ill septic patients. Because sepsis can alter antimicrobial pharmacokinetics, the development of an appropriate dosing strategy to provide adequate concentrations is crucial. The aim of this study was to prospectively validate a new dosing regimen of vancomycin given by continuous infusion (CI) to septic patients. We included all adult septic patients admitted to a mixed intensive care unit (ICU) between January 2012 and May 2013, who were treated with a new vancomycin CI regimen consisting of a loading dose of 35 mg/kg of body weight given as a 4-h infusion, followed by a daily CI dose adapted to creatinine clearance (CrCL), as estimated by the Cockcroft-Gault formula (median dose, 2,112 [1,500 to 2,838] mg). Vancomycin concentrations were measured at the end of the loading dose (T1), at 12 h (T2), at 24 h (T3), and the day after the start of therapy (T4). Vancomycin concentrations of 20 to 30 mg/liter at T2, T3, and T4 were considered adequate. A total of 107 patients (72% male) were included. Median age, weight, and CrCL were 59 (interquartile range [IQR], 48 to 71) years, 75 (IQR, 65 to 85) kg, and 94 (IQR, 56 to 140) ml/min, respectively. Vancomycin concentrations were 44 (IQR, 37 to 49), 25 (IQR, 21 to 32), 22 (IQR, 19 to 28), and 26 (IQR, 22 to 29) mg/liter at T1, T2, T3, and T4, respectively. Concentrations were adequate in 56% (60/107) of patients at T2, in 54% (57/105) at T3, and in 73% (41/56) at T4. This vancomycin regimen permitted rapid attainment of target concentrations in serum for most patients. Concentrations were insufficient in only 16% of patients at 12 h of treatment. |
| Druh dokumentu: | Article |
| Popis souboru: | 1 full-text file(s): application/pdf |
| Jazyk: | English |
| ISSN: | 1098-6596 0066-4804 |
| DOI: | 10.1128/aac.00330-16 |
| Přístupová URL adresa: | https://aac.asm.org/content/aac/60/8/4750.full.pdf https://pubmed.ncbi.nlm.nih.gov/27216073 https://difusion.ulb.ac.be/vufind/Record/ULB-DIPOT:oai:dipot.ulb.ac.be:2013/236869/Details https://aac.asm.org/content/aac/60/8/4750.full.pdf https://espace.library.uq.edu.au/view/UQ:405869 https://journals.asm.org/doi/pdf/10.1128/AAC.00330-16 https://espace.library.uq.edu.au/view/UQ:405869/UQ405869_OA.pdf https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4958221 |
| Rights: | ASM Journals Non-Commercial TDM |
| Přístupové číslo: | edsair.doi.dedup.....319f8f92e27b86724c0f92c1b9be7406 |
| Databáze: | OpenAIRE |
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Nájsť tento článok vo Web of Science | Abstrakt: | Despite the development of new agents with activity against Gram-positive bacteria, vancomycin remains one of the primary antibiotics for critically ill septic patients. Because sepsis can alter antimicrobial pharmacokinetics, the development of an appropriate dosing strategy to provide adequate concentrations is crucial. The aim of this study was to prospectively validate a new dosing regimen of vancomycin given by continuous infusion (CI) to septic patients. We included all adult septic patients admitted to a mixed intensive care unit (ICU) between January 2012 and May 2013, who were treated with a new vancomycin CI regimen consisting of a loading dose of 35 mg/kg of body weight given as a 4-h infusion, followed by a daily CI dose adapted to creatinine clearance (CrCL), as estimated by the Cockcroft-Gault formula (median dose, 2,112 [1,500 to 2,838] mg). Vancomycin concentrations were measured at the end of the loading dose (T1), at 12 h (T2), at 24 h (T3), and the day after the start of therapy (T4). Vancomycin concentrations of 20 to 30 mg/liter at T2, T3, and T4 were considered adequate. A total of 107 patients (72% male) were included. Median age, weight, and CrCL were 59 (interquartile range [IQR], 48 to 71) years, 75 (IQR, 65 to 85) kg, and 94 (IQR, 56 to 140) ml/min, respectively. Vancomycin concentrations were 44 (IQR, 37 to 49), 25 (IQR, 21 to 32), 22 (IQR, 19 to 28), and 26 (IQR, 22 to 29) mg/liter at T1, T2, T3, and T4, respectively. Concentrations were adequate in 56% (60/107) of patients at T2, in 54% (57/105) at T3, and in 73% (41/56) at T4. This vancomycin regimen permitted rapid attainment of target concentrations in serum for most patients. Concentrations were insufficient in only 16% of patients at 12 h of treatment. |
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| ISSN: | 10986596 00664804 |
| DOI: | 10.1128/aac.00330-16 |