A new regimen for continuous infusion of vancomycin in critically ill patients.
Antimicrob Agents Chemother. 2016 May 23;
Authors: Cristallini S, Hites M, Kabtouri H, Roberts JA, Beumier M, Cotton F, Lipman J, Jacobs F, Vincent JL, Creteur J, Taccone FS
Despite the development of new agents with anti-Gram positive bacterial activity, vancomycin remains one of the primary antibiotics in septic critically ill patients. Because sepsis can alter antimicrobial pharmacokinetics, development of an appropriate dosing strategy to provide adequate concentrations is crucial. The aim of this study was to prospectively validate a new dosing regimen of vancomycin given by continuous infusion (CI) in septic patients. We included all adult septic patients admitted to a mixed ICU between January 2012 and May 2013, who were treated with a new vancomycin CI regimen consisting of a loading dose of 35 mg/kg body weight given as a 4-hr infusion followed by a daily CI dose adapted to creatinine clearance (CrCL), as estimated by the Cockcroft-Gault formula (median dose: 2112 [1500-2838]). Vancomycin concentrations were measured at the end of the loading dose (T1), at 12-hrs (T2), 24-hrs (T3), and then the day after (T4) the start of therapy. Vancomycin concentrations of 20-30 mg/L at T2, T3 and T4 were considered adequate. A total of 107 patients (72% male) were included. Median age, weight and CrCL were 59[IQR: 48-71] years, 75[65-85] kg, and 94[56-140] ml/min, respectively. Vancomycin concentrations were 44[37-49], 25[21-32], 22[19-28], and 26[22-29] mg/L at T1, T2, T3, and T4, respectively. Concentrations were adequate in 56% (60/107) of patients at T2, in 54% (57/105) at T3 and in 73% (41/56) at T4. This vancomycin regimen permitted rapid serum concentration target attainment in most patients. Concentrations were insufficient in only 16% of patients at 12 hours of treatment.
PMID: 27216073 [PubMed - as supplied by publisher]