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Achievement of Vancomycin Therapeutic Goals in Critically Ill Patients: Early Individualization May Be Beneficial.

Shahrami B, Najmeddin F, Mousavi S, Ahmadi A, Rouini MR, Sadeghi K, Mojtahedzadeh M - Crit Care Res Pract (2016)

Bottom Line: Steady state AUCs were significantly higher in group 2 compared with group 1 (665.9 ± 136.5 mg·hr/L versus 490.7 ± 101.1 mg·hr/L) (P = 0.008).Conclusions.With early individualized dosing regimen, significantly more patients achieved peak and trough steady state concentrations.

View Article: PubMed Central - PubMed

Affiliation: Clinical Pharmacy Department, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran 14155/6451, Iran.

ABSTRACT
Objective. The aim of our study was to assess and validate the effectiveness of early dose adjustment of vancomycin based on first dose monitoring in achieving target recommended goal in critically ill patients. Methods. Twenty critically ill patients with sepsis received loading dose of 25 mg/kg of vancomycin and then were randomly assigned to 2 groups. Group 1 received maximum empirical doses of vancomycin of 15 mg/kg every 8 hrs. In group 2, the doses were individualized based on serum concentrations of vancomycin. First dose nonsteady state sampling was used to calculate pharmacokinetic parameters of the patients within 24 hours. Results. Steady state trough serum concentrations were significantly higher in group 2 in comparison with group 1 (19.4 ± 4.4 mg/L versus 14.4 ± 4.3 mg/L) (P = 0.03). Steady state AUCs were significantly higher in group 2 compared with group 1 (665.9 ± 136.5 mg·hr/L versus 490.7 ± 101.1 mg·hr/L) (P = 0.008). Conclusions. With early individualized dosing regimen, significantly more patients achieved peak and trough steady state concentrations. In the context of pharmacokinetic/pharmacodynamic goal of area under the time concentration curve to minimum inhibitory concentration (AUC/MIC) ≥400 and also to obtain trough serum concentration of vancomycin of ≥15 mg/L, it is necessary to individualize doses of vancomycin in critically ill patients.

No MeSH data available.


Related in: MedlinePlus

Structure of study design.
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fig1: Structure of study design.

Mentions: In the middle of the study, due to observation of significant differences in our primary outcome of frequencies of patients who had failed to achieve AUC ≥400 mg·hr/L in 20 patients (10 patients in each group), we halted the study to avoid wasting resources. Vancomycin serum concentrations of 108 samples were assayed. A total of 20 patients were assigned to the second phase and 2 cases were excluded based on the exclusion criteria (Figure 1).


Achievement of Vancomycin Therapeutic Goals in Critically Ill Patients: Early Individualization May Be Beneficial.

Shahrami B, Najmeddin F, Mousavi S, Ahmadi A, Rouini MR, Sadeghi K, Mojtahedzadeh M - Crit Care Res Pract (2016)

Structure of study design.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4814628&req=5

fig1: Structure of study design.
Mentions: In the middle of the study, due to observation of significant differences in our primary outcome of frequencies of patients who had failed to achieve AUC ≥400 mg·hr/L in 20 patients (10 patients in each group), we halted the study to avoid wasting resources. Vancomycin serum concentrations of 108 samples were assayed. A total of 20 patients were assigned to the second phase and 2 cases were excluded based on the exclusion criteria (Figure 1).

Bottom Line: Steady state AUCs were significantly higher in group 2 compared with group 1 (665.9 ± 136.5 mg·hr/L versus 490.7 ± 101.1 mg·hr/L) (P = 0.008).Conclusions.With early individualized dosing regimen, significantly more patients achieved peak and trough steady state concentrations.

View Article: PubMed Central - PubMed

Affiliation: Clinical Pharmacy Department, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran 14155/6451, Iran.

ABSTRACT
Objective. The aim of our study was to assess and validate the effectiveness of early dose adjustment of vancomycin based on first dose monitoring in achieving target recommended goal in critically ill patients. Methods. Twenty critically ill patients with sepsis received loading dose of 25 mg/kg of vancomycin and then were randomly assigned to 2 groups. Group 1 received maximum empirical doses of vancomycin of 15 mg/kg every 8 hrs. In group 2, the doses were individualized based on serum concentrations of vancomycin. First dose nonsteady state sampling was used to calculate pharmacokinetic parameters of the patients within 24 hours. Results. Steady state trough serum concentrations were significantly higher in group 2 in comparison with group 1 (19.4 ± 4.4 mg/L versus 14.4 ± 4.3 mg/L) (P = 0.03). Steady state AUCs were significantly higher in group 2 compared with group 1 (665.9 ± 136.5 mg·hr/L versus 490.7 ± 101.1 mg·hr/L) (P = 0.008). Conclusions. With early individualized dosing regimen, significantly more patients achieved peak and trough steady state concentrations. In the context of pharmacokinetic/pharmacodynamic goal of area under the time concentration curve to minimum inhibitory concentration (AUC/MIC) ≥400 and also to obtain trough serum concentration of vancomycin of ≥15 mg/L, it is necessary to individualize doses of vancomycin in critically ill patients.

No MeSH data available.


Related in: MedlinePlus