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vancomycin trough

Rebecca Maxson, Julia Pate, Jessica Starr
BACKGROUND: Current vancomycin dosing guidelines recommend targeting trough concentrations of 15-20 mg/L in complicated infections to avoid treatment failure and resistance. How to accomplish this in the intermittent hemodialysis (IHD) population has not been adequately described. A weight-based vancomycin dosing protocol for IHD patients was developed to provide standardization of vancomycin dosing for this patient population. Prior to implementation of this protocol, clinical pharmacists used their individual judgment for dosing and monitoring...
October 19, 2016: Renal Failure
Kristen A O'Brien, Steve Mok
BACKGROUND: Dosing vancomycin to achieve target concentrations of 15 to 20 mg/L has been recommended for select infections. To date, few vancomycin nomograms designed to target these higher concentrations have been published, and only one has been published in North America. Based on the success of this nomogram in developing empiric vancomycin regimens that achieve higher target trough concentrations with low rates of nephrotoxicity, a vancomycin nomogram targeting concentrations of 15 to 20 mg/L was developed and implemented at Emory University Hospital and Emory University Hospital Midtown...
November 2015: Hospital Pharmacy
Katherine E McQueen, Dana W Clark
OBJECTIVES: To determine if the incidence of nephrotoxicity is higher in pediatric patients treated with the combination of vancomycin and piperacillin-tazobactam, compared to patients treated with vancomycin alone. Secondary objectives were to determine if admission to an intensive care unit (ICU), higher serum vancomycin trough concentrations (>15 mg/L), or receipt of other nephrotoxic agents were related to the development of nephrotoxicity. METHODS: This was a retrospective, single-center, cohort study of 79 patients treated with vancomycin and 106 patients treated with vancomycin and pipracillin/tazobacatam (TZP)...
July 2016: Journal of Pediatric Pharmacology and Therapeutics: JPPT: the Official Journal of PPAG
Sasima Tongsai, Pornpan Koomanachai
BACKGROUND: Recent guidelines have recommended vancomycin trough levels of 15-20 mg/L for treatment of serious infections caused by methicillin-resistant Staphylococcus aureus (MRSA). However, high trough levels may increase risk of nephrotoxicity and mortality, and high vancomycin trough levels have not been well studied. This study was designed to combine safety and efficacy results from independent studies and to compare between high and low vancomycin trough levels in the treatment of MRSA-infected patients using meta-analysis...
September 29, 2016: BMC Research Notes
Keita Hirai, Hidetoshi Ishii, Takayuki Shimoshikiryo, Tatsuki Shimomura, Daiki Tsuji, Kazuyuki Inoue, Toshihiko Kadoiri, Kunihiko Itoh
BACKGROUND: Augmented renal clearance (ARC) has frequently been observed in critically ill patients. The risk factors for ARC in patients, including those in the general ward, and their influences on vancomycin (VCM) treatment remain unclear. The aims of this study were to investigate the risk factors for ARC and to evaluate the influence of ARC on the pharmacokinetic parameters of VCM. METHODS: This study included a total of 292 patients with VCM treatment who had normal serum creatinine concentrations...
September 23, 2016: Therapeutic Drug Monitoring
Loren Trager
No abstract text is available yet for this article.
October 2016: Journal of Pharmacy Practice
J N Moore, J R Healy, B N Thoma, M M Peahota, M Ahamadi, L Schmidt, N C Cavarocchi, W K Kraft
The literature on the pharmacokinetics of vancomycin in patients undergoing extracorporeal membrane oxygenation (ECMO) therapy is sparse. A population pharmacokinetic (PK) model for vancomycin in ECMO patients was developed using a nonlinear mixed effects modeling on the concentration-time profiles of 14 ECMO patients who received intravenous vancomycin. Model selection was based on log-likelihood criterion, goodness of fit plots, and scientific plausibility. Identification of covariates was done using a full covariate model approach...
September 2016: CPT: Pharmacometrics & Systems Pharmacology
Andrew P Smith, Catherine A Millares-Sipin, Marian James, Henry Cohen
OBJECTIVES: Evaluate the clinical impact of pharmacist-initiated vancomycin monitoring and dosing in a long-term care setting. DESIGN: Single-center, pretest, post-test design. SETTING: Rutland Nursing Home, Brooklyn, New York. PARTICIPANTS: Nursing facility residents treated with intravenous vancomycin (N = 198). OUTCOME MEASURES: The primary objective is to determine the incidence of acute kidney injury (AKI) a year before and a year after implementation of a pharmacist-initiated vancomycin-monitoring protocol...
September 2016: Consultant Pharmacist: the Journal of the American Society of Consultant Pharmacists
Janko Samardzic, Anne Smits, Isabel Spriet, Ivan Soldatovic, Andrew Atkinson, Milica Bajcetic, John N Van Den Anker, Karel Allegaert
Substantial interassay variability (up to 20%) has been described for vancomycin immunoassays in adults, but the impact of neonatal matrix is difficult to quantify because of blood volume constraints in neonates. However, we provide circumstantial evidence for a similar extent of variability. Using the same vancomycin dosing regimens and confirming similarity in clinical characteristics, vancomycin trough concentrations measured by PETINIA (2011-2012, n = 400) were 20% lower and the mean difference was 1.93 mg/L compared to COBAS (2012-2014, n = 352) measurements...
2016: BioMed Research International
Peyman Arfa, Abdollah Karimi, Sedigheh Rafiei Tabatabaei, Alireza Fahimzad, Shahnaz Armin, Mohammad Sistanizad
Concerns about increasing bacterial resistance to vancomycin, have caused the adult treatment guidelines to recommend higher trough concentrations based on the type and location of infectious disease. Although these recommendations are not specific to children, the values can be extrapolated. This prospective study was designed to evaluate efficacy of current vancomycin dosing recommendations to achieve therapeutic trough serum concentration in pediatric patients. Laboratory data, vancomycin dosing and subsequent serum concentrations of children in a community teaching pediatrics hospital were collected and analyzed...
2016: Iranian Journal of Pharmaceutical Research: IJPR
L Tang, J Fang, S N Wang, X H Weng, J J Li, E N Shang
OBJECTIVE: To evaluate the clinical efficacy and safety of vancomycin and linezolid for the treatment of gram-positive neonatal bacterial sepsis. METHOD: The data of neonates diagnosed as gram-positive bacterial sepsis in neonatology department of Suzhou Municipal Hospital from June 2009 to December 2015 were retrospectively collected. These neonates were divided into vancomycin group and linezolid group. Propensity score matching (PSM) on baseline variables was used to balance the two groups by identifying a comparable group of neonates who received vancomycin and linezolid therapy...
September 2016: Zhonghua Er Ke za Zhi. Chinese Journal of Pediatrics
W-X Wei, X-L Qin, D-H Cheng, H Lu, T-T Liu
WHAT IS KNOWN AND OBJECTIVE: Vancomycin is one of the most widely used antibiotics for treating serious Gram-positive infections in children. Few clinical studies have examined the potential risk factors for treatment failure in children receiving vancomycin. The objectives of this study were to evaluate the relationships between vancomycin trough concentration and treatment outcomes in Chinese paediatric patients with suspected Gram-positive infections and to identify baseline characteristics that may affect treatment failure associated with vancomycin use...
August 31, 2016: Journal of Clinical Pharmacy and Therapeutics
Kyung-Hwa Park, Kerryl E Greenwood-Quaintance, Jayawant Mandrekar, Robin Patel
BACKGROUND: We compared tedizolid alone and with rifampin against rifampin and vancomycin plus rifampin in rat model of methicillin-resistant Staphylococcus aureus (MRSA) foreign body-associated osteomyelitis. METHODS: The study strain was a prosthetic joint infection-associated isolate. Steady-state pharmacokinetics for intraperitoneal administration of tedizolid, vancomycin, and rifampin were determined in uninfected rats. MRSA was inoculated into the proximal tibia, and a wire was implanted...
August 22, 2016: Antimicrobial Agents and Chemotherapy
Soomal Mohsin-Shaikh, Poonam Lumb
AIM: To audit whether a new paediatric vancomycin guideline is being adhered to and if therapeutic levels are being achieved. METHOD: Data on doses, age, weight, vancomycin levels, time taken and renal function were collected prospectively by reviewing drug charts of paediatric patients on vancomycin. The patients were followed for their whole vancomycin journey in order to observe if the guidelines were followed throughout. Data were collected between 7th and 30th January 2015...
September 2016: Archives of Disease in Childhood
C R Early, J M Park, M P Dorsch, K T Pogue, S M Hanigan
BACKGROUND: Two case reports suggest that metronidazole treatment for Clostridium difficile infections (CDI) increases tacrolimus (TAC) trough levels. The primary objective of this study was to determine the clinical significance of this potential interaction in transplant patients receiving CDI treatment. Currently, no robust literature exists to estimate a magnitude of pharmacokinetic interaction between metronidazole and TAC. METHODS: In this retrospective study, the effects of CDI and metronidazole treatment on TAC levels in 52 adult solid organ transplant patients were investigated...
October 2016: Transplant Infectious Disease: An Official Journal of the Transplantation Society
Zhi-Kang Ye, Yao-Long Chen, Ken Chen, Xiang-Lin Zhang, Guan-Hua Du, Bei He, Da-Kui Li, You-Ning Liu, Ke-Hu Yang, Ying-Yuan Zhang, Suo-Di Zhai
BACKGROUND: Guideline development should be based on the quality of evidence, balance of benefits and harms, economic evaluation and patients' views and preferences. Therefore, these factors were considered in the development of a new guideline for therapeutic drug monitoring (TDM) of vancomycin. OBJECTIVES: To develop an evidence-based guideline for vancomycin TDM and to promote standardized vancomycin TDM in clinical practice in China. METHODS: We referred to the WHO Handbook for Guideline Development and used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system to rate the quality of evidence and grade the strength of recommendations, according to economic evaluation and patients' views and preferences...
July 11, 2016: Journal of Antimicrobial Chemotherapy
Benjamin M Hammer, Allison B Lardieri, Jill A Morgan
OBJECTIVES: Because of increases in antimicrobial resistance, the use of vancomycin in late-onset sepsis has come under scrutiny. The primary outcome of this study was to determine if vancomycin for the treatment of late-onset sepsis in the neonatal intensive care unit (NICU) was being discontinued within 72 hours according to the existing protocol. Secondary outcomes included the appropriateness of therapeutic drug monitoring associated with vancomycin, and renal dysfunction associated with the use of vancomycin in the NICU outside of the 72-hour policy...
May 2016: Journal of Pediatric Pharmacology and Therapeutics: JPPT: the Official Journal of PPAG
John P Prybylski
Effective treatment of complicated methicillin-resistant Staphylococcus aureus (MRSA) infections with vancomycin requires a 24-h area under the concentration-time curve (AUC24) to minimum inhibitory concentration (MIC) ratio of at least 400. To ensure goal AUC24 has been reached requires either dosing to concentrations strongly associated with nephrotoxicity, measurement of patient-specific pharmacokinetics, or use of Bayesian statistics. In this study, we show a method of determining patient-specific pharmacokinetics and dosing to therapeutic AUC24 while minimizing potentially toxic concentrations, guided by only trough measurements...
July 7, 2016: Clinical Pharmacokinetics
Spencer H Durham, Kimberly B Garza, Lea S Eiland
PURPOSE: The association between vancomycin dosage and serum trough vancomycin concentrations in pediatric patients with cystic fibrosis (CF) was examined. METHODS: A retrospective chart review was conducted for pediatric patients with CF who received vancomycin between 2006 and 2012 at a children's hospital. Admission-level data, including vancomycin dosage regimens and corresponding serum trough vancomycin concentrations, were collected. Student's t tests, analysis of variance, and Pearson's correlation coefficients were used to test for associations between vancomycin dosage and trough concentrations...
July 1, 2016: American Journal of Health-system Pharmacy: AJHP
Shankar Lanke, Tian Yu, Joseph E Rower, Alfred H Balch, E Kent Korgenski, Catherine M Sherwin
Vancomycin is a first-line treatment for β-lactam-resistant Gram-positive bacterial infections. Understanding the pharmacokinetic (PK) and pharmacodynamic (PD) characteristics of vancomycin in an adolescent population is of clinical importance in this often overlooked pediatric population. This retrospective study investigated vancomycin PK-PD in an adolescent cohort (12 to 18 years of age) of 463 patients (57% male, 81% white) admitted to the Intermountain Healthcare System between January 2006 and December 2013...
June 13, 2016: Journal of Clinical Pharmacology
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