Evaluation of a dosing regimen for continuous vancomycin infusion in critically ill patients:an observational study in intensive care unit patients

TY - JOUR

T1 - Evaluation of a dosing regimen for continuous vancomycin infusion in critically ill patients:an observational study in intensive care unit patients

AU - Saugel, Bernd

AU - Gramm, Carolin

AU - Wagner, Julia Y

AU - Messer, Marlena

AU - Lahmer, Tobias

AU - Meidert, Agnes S

AU - Schmid, Roland M

AU - Huber, Wolfgang

N1 - Copyright © 2014 Elsevier Inc. All rights reserved.

PY - 2014

Y1 - 2014

N2 - PURPOSE: We aimed to evaluate a dosing algorithm for continuous vancomycin administration in intensive care unit patients.MATERIALS AND METHODS: This observational study was conducted in a medical intensive care unit (German university hospital; June 2012-February 2013). Following a loading dose of 20 mg per kg actual body weight, vancomycin was administered continuously (20 or 30 mg of vancomycin per kg actual body weight over 24 hours depending on renal function). The vancomycin infusion rate was adjusted to achieve a target serum vancomycin concentration of 20-30 mg/L.RESULTS: Vancomycin was administered for a median (interquartile range) of 7 (5-9) days. The median vancomycin dose given as an initial bolus was 1750 (1400-2000) mg. The median daily vancomycin dose ranged from 480 (180-960) mg (day 6) to 3.120 (2596-3980) mg (day 1). Altogether, the achieved median serum vancomycin concentration was 29.0 (25.2-33.2) mg/L. On treatment days 1 to 7, we observed target serum vancomycin levels (20-30 mg/L) in 48%, 39%, 33%, 26%, 43%, 57%, and 69% of patients. Supra-therapeutic serum vancomycin concentrations (>30 mg/L) were observed in 36%, 52%, 61%, 63%, 39%, 19%, and 15% of patients on treatment days 1 to 7.CONCLUSIONS: The evaluated vancomycin dosing regimen for continuous infusion allowed rapid achievement of sufficient vancomycin serum levels. However, we frequently observed supra-therapeutic serum vancomycin concentrations in the first days of vancomycin treatment.

AB - PURPOSE: We aimed to evaluate a dosing algorithm for continuous vancomycin administration in intensive care unit patients.MATERIALS AND METHODS: This observational study was conducted in a medical intensive care unit (German university hospital; June 2012-February 2013). Following a loading dose of 20 mg per kg actual body weight, vancomycin was administered continuously (20 or 30 mg of vancomycin per kg actual body weight over 24 hours depending on renal function). The vancomycin infusion rate was adjusted to achieve a target serum vancomycin concentration of 20-30 mg/L.RESULTS: Vancomycin was administered for a median (interquartile range) of 7 (5-9) days. The median vancomycin dose given as an initial bolus was 1750 (1400-2000) mg. The median daily vancomycin dose ranged from 480 (180-960) mg (day 6) to 3.120 (2596-3980) mg (day 1). Altogether, the achieved median serum vancomycin concentration was 29.0 (25.2-33.2) mg/L. On treatment days 1 to 7, we observed target serum vancomycin levels (20-30 mg/L) in 48%, 39%, 33%, 26%, 43%, 57%, and 69% of patients. Supra-therapeutic serum vancomycin concentrations (>30 mg/L) were observed in 36%, 52%, 61%, 63%, 39%, 19%, and 15% of patients on treatment days 1 to 7.CONCLUSIONS: The evaluated vancomycin dosing regimen for continuous infusion allowed rapid achievement of sufficient vancomycin serum levels. However, we frequently observed supra-therapeutic serum vancomycin concentrations in the first days of vancomycin treatment.

U2 - 10.1016/j.jcrc.2013.12.007

DO - 10.1016/j.jcrc.2013.12.007

M3 - SCORING: Journal article

C2 - 24456810

VL - 29

SP - 351

EP - 355

JO - J CRIT CARE

JF - J CRIT CARE

SN - 0883-9441

IS - 3

ER -