Vancomycin Dosing Considerations in a Real-World Cohort of Obese and Extremely Obese Patients

Pharmacotherapy
Haley J MorrillKerry L LaPlante

Abstract

To compare the effects of empiric vancomycin dosing regimens on attainment of optimal target trough concentrations in obese (body mass index [BMI] 30-40 kg/m(2) ) and extremely obese (BMI ≥ 40 kg/m(2) ) patients. Retrospective cohort study. National Veterans Affairs standardized databases. A total of 263 obese and 71 extremely obese (actual body weight range 72-244 kg in both groups) inpatients from all Veterans Affairs facilities nationally who had suspected methicillin-resistant Staphylococcus aureus pneumonia and were treated with vancomycin between 2002 and 2012. Patients with steady-state trough concentrations (measured ≤ 2 hours before the next vancomycin dose) and no evidence of acute kidney injury before vancomycin initiation were included. Logistic regression models were used to measure the effect of various vancomycin dosing regimens on attainment of optimal target trough concentrations (15-20 mg/L). The mean total daily vancomycin dose was lower in obese versus extremely obese patients (2005 ± 736 vs 2306 ± 934 mg, p<0.05). The mean weight-based daily dose was higher in obese patients (20 ± 7 vs 17 ± 7 mg/kg/day, p<0.05). In each group, ~ 20% of patients achieved optimal target trough concentrations. In obese patient...Continue Reading

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Citations

Oct 21, 2016·Renal Failure·Rebecca MaxsonJessica Starr
Mar 16, 2017·Expert Review of Clinical Pharmacology·Ronald G HallKenna D Payne
Jul 16, 2017·The Annals of Pharmacotherapy·Yookyung Christy ChoiJames M Hollands
Dec 22, 2017·The Annals of Pharmacotherapy·Cheryl DurandPaul Belliveau
Mar 22, 2018·Therapeutic Drug Monitoring·Timothy M RawsonAlison H Holmes
Sep 5, 2017·Pharmacotherapy·Lina MengStan C Deresinski
May 1, 2018·Nephron·Juan Carlos Q VelezGautam M Phadke
May 20, 2017·American Journal of Health-system Pharmacy : AJHP : Official Journal of the American Society of Health-System Pharmacists·Matthew L BrownDarrell T Childress

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