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vancomycin trough

Chien-Fang Fu, Jiun-Da Huang, Jann-Tay Wang, Shu-Wen Lin, Chien-Chih Wu
BACKGROUND: Vancomycin is a standard treatment for methicillin-resistant Staphylococcus aureus (MRSA) bacteremia, and its efficacy is closely linked to the recommended serum trough concentration of 15-20 mg/L. However, it is unknown how the pre-dialysis trough serum concentration (Cpre-HD) correlates with MRSA eradication in renal failure patients undergoing intermittent hemodialysis (HD). OBJECTIVE: To evaluate the relationship between Cpre-HD and the treatment outcomes in this population...
2018: PloS One
Chih-Ning Cheng, Shu-Wen Lin, Chien-Chih Wu
Linezolid, an oxazolidinone antibiotic, does not required dose adjustment in patients with Child's class A and B liver cirrhosis. The dose adjustment data for Child's class C liver cirrhosis is inadequate. We reported a case of Child's class C liver cirrhosis, in which lactic acidosis, an adverse effect related to prolonged use, occurred only after two weeks of linezolid treatment. A 63-year old male had underlying diseases, such as end-stage renal disease (ESRD) and Child's class C liver cirrhosis, and was admitted for hepatic encephalopathy management and liver transplantation evaluation...
March 1, 2018: Journal of Infection and Chemotherapy: Official Journal of the Japan Society of Chemotherapy
Leesa Prunty, David Miskell
OBJECTIVE: To report the case of an infant who required high-dose vancomycin therapy after an unsuccessful gastroschisis repair surgery. CASE SUMMARY: An infant born at 35 weeks and 5 days of gestation underwent a gastroschisis repair on day of life 47. The repair was unsuccessful causing fluid backup and accumulation into the stomach. A replogle was placed to allow for suctioning of this fluid. During this admission, the patient received 3 courses of vancomycin...
January 1, 2018: Journal of Pharmacy Practice
Paul Lewis
BACKGROUND: Serum trough concentrations as the sole means of monitoring safety and efficacy of vancomycin are insufficient. The daily area under the curve (AUC24) of serum concentration versus time to minimum inhibitory concentration (MIC) ratio of greater than 400 mg*hr/L has emerged as a more robust dosing target. A simple and practical method to extrapolate AUC24 from troughs is needed. MATERIALS AND METHODS: This mathematical model computes the median and range AUC24 using the dose in mg/kg and the observed serum trough concentration...
February 27, 2018: Therapeutic Drug Monitoring
Stuart Evan Bond, Shelley P Crowther, Suman Adhikari, Adriana J Chubaty, Ping Yu, Jay P Borchard, Craig Steven Boutlis, Wilfred Winston Yeo, Spiros Miyakis
BACKGROUND: Internet-based learning for health professional education is increasing. It offers advantages over traditional learning approaches, as it enables learning to be completed at a time convenient to the user and improves access where facilities are geographically disparate. We developed and implemented the Vancomycin Interactive (VI) e-learning tool to improve knowledge on the clinical use of the antibiotic vancomycin, which is commonly used for treatment of infections caused by methicillin-resistant Staphylococcus aureus (MRSA)...
February 26, 2018: JMIR Medical Education
V Goti, A Chaturvedula, M J Fossler, S Mok, J T Jacob
BACKGROUND: Despite being in clinical use for about six decades, vancomycin dosing remains perplexing and complex. METHODS: A population pharmacokinetic modeling and simulation approach was used to evaluate the efficiency of the current nomogram-based dosing of vancomycin. Serum vancomycin concentrations were obtained as a part of routine therapeutic drug monitoring (TDM) from two 500-bed academic medical centers. A population pharmacokinetic model was first built using these TDM data...
February 20, 2018: Therapeutic Drug Monitoring
Royanne L Lichliter, Lynea E Tremewan, Nicole M Shonka, Jennifer E Mehnert, Laney Brennan, Jodi M Thrasher, Teri L Hernandez
Repeated venipunctures and fingersticks to confirm serum drug concentrations cause pain and dissatisfaction for pediatric patients and their families. In many organizations, the standard of care to obtain therapeutic serum drug concentrations by peripheral venipuncture or capillary fingerstick, even when the patient has an existing peripheral intravenous catheter (PIV) or central venous catheter (CVC). The primary objective of this study was to assess agreement between serum tobramycin/vancomycin concentrations collected from a CVC or PIV, versus venipuncture or fingerstick...
February 20, 2018: Journal for Specialists in Pediatric Nursing: JSPN
Abdullah Alsultan, Manal Abouelkheir, Saeed Alqahtani, Ahmad Aljabri, Ali M Somily, Sarah Alsubaie, Abdulkarim Alrabiaah, Elham Bukhari, Fahad Alzamil
INTRODUCTION: Several studies have reported that trough levels may not be optimal for monitoring vancomycin therapy, because of overexposure and nephrotoxicity risks. Therefore, we developed a population pharmacokinetic model to optimize vancomycin dosing and monitoring in pediatrics. METHODS: Data were retrospectively collected on 76 pediatric patients aged 1-12 years, admitted to general pediatric wards or ICUs at King Saud University Medical City, Riyadh, Saudi Arabia...
February 15, 2018: Pediatric Infectious Disease Journal
Chi-Ju Yang, Chia-Wei Wu, Chien-Chih Wu
BACKGROUND: The optimal dosing regimen of vancomycin for critically ill patients receiving continuous veno-venous hemofiltration (CVVH) remains controversial, not to mention those with concurrent use of extracorporeal membrane oxygenation (ECMO). We aimed to determine if a new dosing regimen can achieve the target vancomycin trough concentration (Ctrough) of 10-20 μg/mL in patients receiving CVVH with or without ECMO. METHODS: We conducted a retrospective study by enrolling patients who received vancomycin while undergoing CVVH...
February 14, 2018: Therapeutic Drug Monitoring
Drayton A Hammond, Taylor B James, Lexis N Atkinson, Jacob T Painter, Katherine Lusardi
BACKGROUND: Clinical practice guidelines for initiation and therapeutic drug monitoring, but not timing, of vancomycin dosing exist at many institutions. Scheduling vancomycin trough measurements and doses around the morning blood sample collection could yield more interpretable troughs and increase patient safety. OBJECTIVE: To evaluate the appropriateness of blood sample collection times for vancomycin trough measurements before and after an initiative to change the timing of blood sampling to determine vancomycin doses and trough levels in a medical intensive care unit...
February 2018: Critical Care Nurse
Vincent Peyko, Michelle Friedman-Jakubovics
PURPOSE: A novel approach to vancomycin level monitoring is described. METHODS: Vancomycin trough orders were added to the medication ordering system of a large teaching hospital and were generated when vancomycin was ordered. Pharmacists adjusted the order time so that the level was drawn appropriately. After pharmacist validation, the trough order appeared within the nursing medication list, and nurses were required to document when the level was drawn. Outcomes were evaluated before (retrospective group) and after (prospective group) implementation of this initiative...
February 1, 2018: American Journal of Health-system Pharmacy: AJHP
Sheng-Hsuan Tseng, Chuan Poh Lim, Qi Chen, Cheng Cai Tang, Sing Teang Kong, Paul Chi-Lui Ho
Bacterial sepsis is a major cause of morbidity and mortality in neonates, especially those involving methicillin-resistant Staphylococcus aureus (MRSA). Guidelines by the Infectious Diseases Society of America recommend vancomycin 24-hour area under the concentration-time curve to MIC ratio (AUC24/MIC, hr) > 400 as the best predictor of successful treatment against MRSA infections when MIC (mg/L) is ≤ 1. The relationship between steady state vancomycin trough concentrations and AUC24 (mg ⋅ hr/L) has not been studied in an Asian neonatal population...
January 22, 2018: Antimicrobial Agents and Chemotherapy
Stacey Tkachuk, Kyle Collins, Mary H H Ensom
BACKGROUND: In adults, the area under the concentration-time curve (AUC) divided by the minimum inhibitory concentration (MIC) is associated with better clinical and bacteriological response to vancomycin in patients with methicillin-resistant Staphylococcus aureus who achieve target AUC/MIC ≥ 400. This target is often extrapolated to pediatric patients despite the lack of similar evidence. The impracticalities of calculating the AUC in practice means vancomycin trough concentrations are used to predict the AUC/MIC...
January 17, 2018: Paediatric Drugs
Raid W Amin, Rodney P Guttmann, Quianna R Harris, Janesha W Thomas
Vancomycin is a key antibiotic used in the treatment of multiple conditions including infections associated with cystic fibrosis and methicillin-resistant Staphylococcus aureus. The present study sought to develop a model based on empirical evidence of optimal vancomycin dose as judged by clinical observations that could accelerate the achievement of desired trough level in children with cystic fibrosis. Transformations of dose and trough were used to arrive at regression models with excellent fit for dose based on weight or age for a target trough...
January 10, 2018: Journal of Clinical Pharmacology
Rebecca S Pettit, Stacy J Peters, Erin J McDade, Kaci Kreilein, Radha Patel, Kevin Epps, Frederick Kittell, Mariela A Duval, Jeffery T Zobell
OBJECTIVES: Vancomycin is commonly used in patients with cystic fibrosis (CF) to treat acute pulmonary exacerbations, but few guidelines exist to help dose and monitor patients. The objective of this study was to assess vancomycin use and monitoring strategies at Cystic Fibrosis Foundation (CFF)-accredited centers in hopes of developing and implementing vancomycin dosing and monitoring standards. METHODS: An anonymous national cross-sectional survey of pharmacists affiliated with CFF-accredited pediatric and/or adult centers was performed by using Surveymonkey...
November 2017: Journal of Pediatric Pharmacology and Therapeutics: JPPT: the Official Journal of PPAG
Theresa M Fiorito, Megan K Luther, Penelope H Dennehy, Kerry L LaPlante, Kelly L Matson
BACKGROUND: Vancomycin is frequently used to treat methicillin-resistant Staphylococcus aureus (MRSA) infections in pediatric patients. Vancomycin exposure may lead to an increase in frequency of nephrotoxicity. Our aim was to conduct a systematic review to describe predictors of nephrotoxicity associated with vancomycin, including documented trough concentrations ≥15mg/L. We also aimed to use a meta-analysis to assess the impact of a vancomycin trough ≥15 mg/L on nephrotoxicity...
December 26, 2017: Pediatric Infectious Disease Journal
Fawzy Elbarbry
After more than six decades of its use as the mainstay antibiotic for the treatment of multidrug-resistant Gram-positive bacterial infections, dosing and monitoring of vancomycin therapy have not been optimized. The current vancomycin therapeutic guidelines recommend empiric doses of 15-20 mg/kg administered by intermittent infusion every 8-12 h in patients with normal kidney function. Additionally, the guidelines recommend trough concentration of 15-20 mg/L as a therapeutic goal for adult patients with severe infections...
December 19, 2017: European Journal of Drug Metabolism and Pharmacokinetics
Michael N Neely, Lauren Kato, Gilmer Youn, Lironn Kraler, David Bayard, Michael van Guilder, Alan Schumitzky, Walter Yamada, Brenda Jones, Emi Minejima
We hypothesized that dosing vancomycin to achieve trough concentrations of >15 mg/liter overdoses many adults compared to area under the concentration-time curve (AUC)-guided dosing. We conducted a 3-year, prospective study of vancomycin dosing, plasma concentrations, and outcomes. In year 1, nonstudy clinicians targeted trough concentrations of 10 to 20 mg/liter (infection dependent) and controlled dosing. In years 2 and 3, the study team controlled vancomycin dosing with BestDose Bayesian software to achieve a daily, steady-state AUC/MIC ratio of ≥400, with a maximum AUC value of 800 mg · h/liter, regardless of trough concentration...
February 2018: Antimicrobial Agents and Chemotherapy
Allison Oswalt, Anny-Claude Joseph, Adam Sima, Lisa Kurczewski
BACKGROUND: Vancomycin is a glycopeptide antibiotic that is primarily cleared by renal elimination. Patients with acute brain injury often exhibit augmented renal clearance which has been associated with subtherapeutic vancomycin concentrations. OBJECTIVE: To determine whether population pharmacokinetics accurately predict vancomycin empiric dose frequency in patients with acute brain injury. METHODS: This was a single-center, retrospective cohort study conducted following institutional review board approval at Virginia Commonwealth University Health System...
January 1, 2017: Journal of Pharmacy Practice
Kirsten Tangedal, Jennifer Bolt, Suzanne Len, Ali Bell
Background: Pharmacists in the Regina Qu'Appelle Health Region (RQHR), Saskatchewan, independently dose, monitor, and adjust vancomycin therapy. No framework exists for ongoing competency assessment of pharmacists. Objectives: The primary objective was to determine pharmacists' overall level of competency for all components of the vancomycin prescribing procedure. The secondary objectives were to determine competency for individual prescribing phases, to stratify overall competency in relation to pharmacist and patient factors, and to identify the 3 most frequent errors...
September 2017: Canadian Journal of Hospital Pharmacy
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