Initial vancomycin dosing protocol to achieve therapeutic serum concentrations in patients undergoing hemodialysis

Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America
Sheryl A ZelenitskyLavern M Vercaigne

Abstract

Although recent consensus guidelines proposed more aggressive vancomycin troughs of >10 or 15-20 mg/L for complicated Staphylococcus aureus infections, dosing information to achieve these targets in patients undergoing hemodialysis (HD) is scarce. We used Monte Carlo simulation (MCS) methods with a previously published population-pharmacokinetic model and relevant patient demographics to evaluate and revise our existing vancomycin dosing protocol (1000-mg load followed by 500-mg maintenance dose, with doses infused during the last hour of dialysis). A new protocol (1000-mg load followed by 500-mg maintenance dose for patients <70 kg, 1250-mg followed by 750-mg for those 70-100 kg, and 1500-mg followed by 1000-mg for those >100 kg) was developed and prospectively validated to achieve therapeutic serum troughs in patients undergoing high-flux HD. MCSs predicted that our existing protocol would be suboptimal in more than one-third of patients. Simulations predicted that the new vancomycin dosing protocol would achieve maintenance (pre-HD) troughs of 10-20 mg/L in 86.0% of cases including 15-20 mg/L in 35.2%. In prospective validation, the observed postload trough (pre-HD session 2) was 13.5 ± 3.4 mg/L with 76.9% of levels (20 of 2...Continue Reading

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Citations

Jan 5, 2013·The Canadian Journal of Hospital Pharmacy·Wasim S El NekidyMichelle Dehoorne-Smith
Apr 17, 2015·Seminars in Dialysis·Ameet KarambelkarPaul M Palevsky
Oct 21, 2016·Renal Failure·Rebecca MaxsonJessica Starr
Oct 23, 2015·American Journal of Health-system Pharmacy : AJHP : Official Journal of the American Society of Health-System Pharmacists·Page CrewBrett H Heintz
Sep 15, 2018·The Journal of Antimicrobial Chemotherapy·Katrina HuiCarl M J Kirkpatrick

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