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Elevated Vancomycin Trough Concentration: Increased Efficacy and/or Toxicity?

Elyasi S, Khalili H, Dashti-Khavidaki S, Emadi-Koochak H, Mohammadpour A, Abdollahi A - Iran J Pharm Res (2014)

Bottom Line: Time to normalization of the signs and symptoms of infection did not correlate with the patients' serum vancomycin trough levels.Vancomycin induced nephrotoxicity was detected in 4.3% of the patients.However, more well designed studies with larger sample size needed for better clinical and practical judgment.

View Article: PubMed Central - PubMed

Affiliation: Department of Clinical Pharmacy, Faculty of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran.

ABSTRACT
Vancomycin susceptibility of methicillin-resistant Staphylococcus aureus has been changed over time and its average minimum inhibitory concentration increased from 1.5 to 1.75 mg/L.A recently published guideline by the American Society of Health Pharmacist recommended a daily dose of 15-20 mg/Kg every 8 to 12 hours of vancomycin to achieve a trough concentration between 15-20 mg/L for treatment of severe infections. Medical records of 69 patients from infectious ward of Imam Khomeini hospital, with suspected or confirmed gram-positive infection who had at least one trough level of vancomycin, were evaluated regarding vancomycin therapeutic goal; efficacy and renal safety. Most of patients (60.6%) with severe infections did not achieve the recommended vancomycin trough level during treatment course. Time to normalization of the signs and symptoms of infection did not correlate with the patients' serum vancomycin trough levels. At the end of treatment course, there was no significant correlation between patients' creatinine clearance and vancomycin trough levels (P=0.32). However, patients'cratinine clearance showed a negatively significant correlation with trough level of vancomycin (P=0.01). Vancomycin induced nephrotoxicity was detected in 4.3% of the patients. These data showed that vancomycin trough level may not necessarily assure treatment success, and also it would not essentially predict the risk of vancomycin induced nephrotoxicity. However, more well designed studies with larger sample size needed for better clinical and practical judgment.

No MeSH data available.


Related in: MedlinePlus

The patients’ vancomycin serum trough levels regarding received daily dose
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Figure 1: The patients’ vancomycin serum trough levels regarding received daily dose

Mentions: The patients’ type of infection was categorized in Table 2. Soft tissue infections were common infection and were detected in about half of the patients. Thirty-three patients (47.8%) had at least one biological sample culture in their treatment course, which were positive in about half of them (16 patients). MRSA was the most common isolated microorganism (58.8%). Time (days) to negative culture was compared between three group and no significant difference was detected (P=0.22). There was no any correlation between the patients’ serum vancomycin trough levels and the type of infections (P = 0.21). Actually we could not find a significant correlation between vancomycin total daily dose (p = 0.74), per Kg daily dosing (p= 0.97) and vancomycin trough level. However most of patients receiving ≥3 g/day of vancomycin, had higher (but not significant) serum trough level than who received <3 g/day (P=0.15). (Figure 1)


Elevated Vancomycin Trough Concentration: Increased Efficacy and/or Toxicity?

Elyasi S, Khalili H, Dashti-Khavidaki S, Emadi-Koochak H, Mohammadpour A, Abdollahi A - Iran J Pharm Res (2014)

The patients’ vancomycin serum trough levels regarding received daily dose
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4232790&req=5

Figure 1: The patients’ vancomycin serum trough levels regarding received daily dose
Mentions: The patients’ type of infection was categorized in Table 2. Soft tissue infections were common infection and were detected in about half of the patients. Thirty-three patients (47.8%) had at least one biological sample culture in their treatment course, which were positive in about half of them (16 patients). MRSA was the most common isolated microorganism (58.8%). Time (days) to negative culture was compared between three group and no significant difference was detected (P=0.22). There was no any correlation between the patients’ serum vancomycin trough levels and the type of infections (P = 0.21). Actually we could not find a significant correlation between vancomycin total daily dose (p = 0.74), per Kg daily dosing (p= 0.97) and vancomycin trough level. However most of patients receiving ≥3 g/day of vancomycin, had higher (but not significant) serum trough level than who received <3 g/day (P=0.15). (Figure 1)

Bottom Line: Time to normalization of the signs and symptoms of infection did not correlate with the patients' serum vancomycin trough levels.Vancomycin induced nephrotoxicity was detected in 4.3% of the patients.However, more well designed studies with larger sample size needed for better clinical and practical judgment.

View Article: PubMed Central - PubMed

Affiliation: Department of Clinical Pharmacy, Faculty of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran.

ABSTRACT
Vancomycin susceptibility of methicillin-resistant Staphylococcus aureus has been changed over time and its average minimum inhibitory concentration increased from 1.5 to 1.75 mg/L.A recently published guideline by the American Society of Health Pharmacist recommended a daily dose of 15-20 mg/Kg every 8 to 12 hours of vancomycin to achieve a trough concentration between 15-20 mg/L for treatment of severe infections. Medical records of 69 patients from infectious ward of Imam Khomeini hospital, with suspected or confirmed gram-positive infection who had at least one trough level of vancomycin, were evaluated regarding vancomycin therapeutic goal; efficacy and renal safety. Most of patients (60.6%) with severe infections did not achieve the recommended vancomycin trough level during treatment course. Time to normalization of the signs and symptoms of infection did not correlate with the patients' serum vancomycin trough levels. At the end of treatment course, there was no significant correlation between patients' creatinine clearance and vancomycin trough levels (P=0.32). However, patients'cratinine clearance showed a negatively significant correlation with trough level of vancomycin (P=0.01). Vancomycin induced nephrotoxicity was detected in 4.3% of the patients. These data showed that vancomycin trough level may not necessarily assure treatment success, and also it would not essentially predict the risk of vancomycin induced nephrotoxicity. However, more well designed studies with larger sample size needed for better clinical and practical judgment.

No MeSH data available.


Related in: MedlinePlus