PMID- 22573855
OWN - NLM
STAT- MEDLINE
DCOM- 20130211
LR  - 20131121
IS  - 1537-6591 (Electronic)
IS  - 1058-4838 (Linking)
VI  - 55
IP  - 4
DP  - 2012 Aug
TI  - Initial vancomycin dosing protocol to achieve therapeutic serum concentrations in 
      patients undergoing hemodialysis.
PG  - 527-33
LID - 10.1093/cid/cis458 [doi]
AB  - BACKGROUND: 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. METHODS: 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. RESULTS: 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 26) between 10 and 20 mg/L. The observed maintenance 
      trough was 17.3 +/- 4.0 mg/L with 65.5% (19 of 29) between 10 and 20 mg/L and 89.7% 
      (26 of 29) within 10% of the upper limit (ie, 10-22 mg/L). CONCLUSIONS: In this 
      study, a practical vancomycin dosing protocol for patients undergoing HD was 
      developed and prospectively validated to achieve therapeutic serum concentrations 
      in the clinical setting.
FAU - Zelenitsky, Sheryl A
AU  - Zelenitsky SA
AD  - Faculty of Pharmacy, University of Manitoba, Canada. s_zelenitsky@umanitoba.ca
FAU - Ariano, Robert E
AU  - Ariano RE
FAU - McCrae, Margo L
AU  - McCrae ML
FAU - Vercaigne, Lavern M
AU  - Vercaigne LM
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20120509
PL  - United States
TA  - Clin Infect Dis
JT  - Clinical infectious diseases : an official publication of the Infectious Diseases 
      Society of America
JID - 9203213
RN  - 0 (Anti-Bacterial Agents)
RN  - 6Q205EH1VU (Vancomycin)
SB  - IM
MH  - Aged
MH  - Anti-Bacterial Agents/*administration & dosage/blood/pharmacokinetics
MH  - Computer Simulation
MH  - Drug Administration Schedule
MH  - Drug Monitoring/*methods
MH  - Humans
MH  - Methicillin-Resistant Staphylococcus aureus
MH  - Middle Aged
MH  - Monte Carlo Method
MH  - Prospective Studies
MH  - *Renal Dialysis
MH  - Reproducibility of Results
MH  - Staphylococcal Infections/blood/*drug therapy
MH  - Vancomycin/*administration & dosage/blood/pharmacokinetics
EDAT- 2012/05/11 06:00
MHDA- 2013/02/12 06:00
CRDT- 2012/05/11 06:00
PHST- 2012/05/11 06:00 [entrez]
PHST- 2012/05/11 06:00 [pubmed]
PHST- 2013/02/12 06:00 [medline]
AID - cis458 [pii]
AID - 10.1093/cid/cis458 [doi]
PST - ppublish
SO  - Clin Infect Dis. 2012 Aug;55(4):527-33. doi: 10.1093/cid/cis458. Epub 2012 May 9.