An Initial Vancomycin Dosing Protocol to Achieve Therapeutic Serum Concentrations in Hemodialysis Patients.
Clin Infect Dis. 2012 May 9;
Authors: Zelenitsky SA, Ariano RE, McCrae ML, Vercaigne LM
BackgroundAlthough recent consensus guidelines proposed more aggressive vancomycin troughs of >10 mg/L or 15 to 20 mg/L for complicated Staphylococcus aureus infections, dosing information to achieve these targets in hemodialysis (HD) patients is scarce.MethodsWe 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, with doses infused during the last hour of dialysis). A new protocol (1000 mg load followed by 500 mg maintenance for patients <70 kg, 1250 mg followed by 750 mg for 70 to 100 kg, and 1500 mg followed by 1000 mg for >100 kg) was developed and prospectively validated to achieve therapeutic serum troughs in patients undergoing high-flux HD.ResultsMCS predicted that our existing protocol would be suboptimal in over 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 post-load trough (pre-HD session #2) was 13.5 ± 3.4 mg/L with 76.9.8% (20/26) of levels between 10 and 20 mg/L. The observed maintenance trough was 17.3 ± 4.0 mg/L with 65.5% (19/29) between 10 and 20 mg/L and 89.7% (26/29) within 10% of the upper limit (i.e., 10-22 mg/L).ConclusionIn this study, a practical vancomycin dosing protocol for HD patients was developed and prospectively validated to achieve therapeutic serum concentrations in the clinical setting.
PMID: 22573855 [PubMed - as supplied by publisher]