Development of a vancomycin dosing approach for critically ill patients receiving hybrid hemodialysis using Monte Carlo simulation

SAGE Open Medicine
Susan J Lewis, Bruce A Mueller

Abstract

Prolonged intermittent renal replacement therapy is an increasingly popular treatment for acute kidney injury in critically ill patients that runs at different flow rates and durations than conventional hemodialysis or continuous renal replacement therapies. Pharmacokinetic studies conducted in patients receiving prolonged intermittent renal replacement therapy are scarce; consequently, clinicians are challenged to dose antibiotics effectively. The purpose of this study was to develop vancomycin dosing recommendations for patients receiving prolonged intermittent renal replacement therapy. Monte Carlo simulations were performed in thousands of virtual patients derived from previously published demographic, pharmacokinetic, and dialytic information derived from critically ill patients receiving vancomycin and other forms of renal replacement therapy. We conducted "in silico" vancomycin pharmacokinetic/pharmacodynamics analyses in these patients receiving prolonged intermittent renal replacement therapy to determine what vancomycin dose would achieve vancomycin 24-h area under the curve (AUC24h) of 400-700 mg·h/L, a target associated with positive clinical outcomes. Nine different vancomycin dosing regimens were tested using four...Continue Reading

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Citations

May 5, 2020·Expert Review of Anti-infective Therapy·Soo Min JangBruce A Mueller
May 22, 2019·Antimicrobial Agents and Chemotherapy·Valentina PistolesiEnrico Fiaccadori
Mar 19, 2020·Pharmacy : Journal of Pharmacy, Education and Practice·Paula Brown, Marisa Battistella
Sep 24, 2020·International Journal of Environmental Research and Public Health·Fernanda Moreira de FreitasDaniela Ponce
Sep 9, 2020·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·Thomas J DilworthWarren E Rose

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