Decreasing the time to achieve therapeutic vancomycin concentrations in critically ill patients: developing and testing of a dosing nomogram

被引:42
|
作者
Baptista, Joao Pedro [1 ,2 ]
Roberts, Jason A. [3 ,4 ,5 ,6 ]
Sousa, Eduardo [1 ,2 ]
Freitas, Ricardo [1 ,2 ]
Deveza, Nuno [1 ,2 ]
Pimentel, Jorge [1 ,2 ]
机构
[1] Ctr Hosp Coimbra, Serv Med Intens, P-3000075 Coimbra, Portugal
[2] Univ Coimbra, P-3000075 Coimbra, Portugal
[3] Univ Queensland, Burns Trauma & Crit Care Res Ctr, Brisbane, Qld, Australia
[4] Univ Liverpool, Dept Mol & Clin Pharmacol, Liverpool L69 3BX, Merseyside, England
[5] Royal Brisbane & Womens Hosp, Dept Intens Care Med, Brisbane, Qld, Australia
[6] Royal Brisbane & Womens Hosp, Dept Pharm, Brisbane, Qld, Australia
来源
CRITICAL CARE | 2014年 / 18卷 / 06期
关键词
GLOMERULAR-FILTRATION-RATE; AUGMENTED RENAL CLEARANCE; PLASMA CREATININE CONCENTRATIONS; CARE-UNIT PATIENTS; CONTINUOUS-INFUSION; INTERMITTENT INFUSION; SEPTIC PATIENTS; INFECTIONS; REGIMEN;
D O I
10.1186/s13054-014-0654-2
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Introduction: Achievement of optimal vancomycin exposure is crucial to improve the management of patients with life-threatening infections caused by susceptible Gram-positive bacteria and is of particular concern in patients with augmented renal clearance (ARC). The aim of this study was to develop a dosing nomogram for the administration of vancomycin by continuous infusion for the first 24 hours of therapy based on the measured urinary creatinine clearance (8 h CLCR). Methods: This single-center study included all critically ill patients treated with vancomycin over a 13-month period (group 1), in which we retrospectively assessed the correlation between vancomycin clearance and 8 h CLCR. This data was used to develop a formula for optimised drug dosing. The efficiency of this formula was prospectively evaluated in a second cohort of 25 consecutive critically ill patients (group 2). Vancomycin serum concentrations between 20 to 30 mg/L were considered adequate. ARC was defined as 8 h CLCR more than 130 ml/min/1.73 m(2). Results: The incidence of ARC was 36% (n = 29/79) and 40% (10/25) in group 1 (n = 79) and 2 (n = 25), respectively. The mean serum vancomycin concentration on day 1 was 21.5 (6.4) and 24.5 (5.2) mg/L, for both groups respectively. On the treatment day, vancomycin plasma clearance was 5.12 (1.9) L/h in group 1 and correlated significantly with the 8 h CLCR (r(2) = 0.66; P < 0.001). The achievement of adequate vancomycin serum concentrations in group 2 was 84% (n = 21/25) versus 51% (n = 40/79) -P < 0.005. Conclusions: This new vancomycin nomogram enabled the achievement of adequate serum concentrations in 84% of the patients on the first day of treatment.
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页数:9
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