Prime

Type your tag names separated by a space and hit enter

Optimal dose of vancomycin for treating methicillin-resistant Staphylococcus aureus pneumonia in critically ill patients.

Abstract

A prospective cohort study was performed to determine the optimal dose of vancomycin to maintain a serum trough concentration of at least 15 to 20 mg/l and to assess the efficacy of this target vancomycin concentration in the treatment of methicillin-resistant Staphylococcus aureus pneumonia. Vancomycin pharmacokinetic parameters were estimated using a CAPSIL software program from serum concentrations of 141 patients with pneumonia treated with vancomycin, regardless of methicillin-resistant Staphylococcus aureus status, at a 28-bed medical intensive care unit. Vancomycin trough concentrations and other pharmacokinetic parameters were compared between five groups of patients differing in their renal function: (1) creatinine clearance > or =60 ml/minute, (2) creatinine clearance 30 to 60 ml/minute, (3) creatinine clearance <30 ml/minute, (4) on intermittent haemodialysis, and (5) on continuous renal replacement therapy. More than 70% of patients failed to reach the recommended therapeutic serum trough concentrations: a higher dose of vancomycin is necessary to maintain serum trough concentration at 15 to 20 mg/l, particularly in critically ill patients with creatinine clearance above 60 ml/minute and in those on intermittent haemodialysis. Among patients with methicillin-resistant Staphylococcus aureus pneumonia, no significant differences were observed in the treatment success rate, length of intensive care unit stay, and intensive care unit mortality rate between patients with vancomycin trough concentrations of >20 mg/l, 15 to 20 mg/l and <15 mg/l.

Links

  • FREE Publisher Full Text
  • Authors+Show Affiliations

    ,

    Department of Pulmonary and Critical Care Medicine, Asan Medical Center Seoul, Korea.

    , , , , ,

    Source

    Anaesthesia and intensive care 39:6 2011 Nov pg 1030-7

    MeSH

    APACHE
    Adolescent
    Adult
    Aged
    Anti-Bacterial Agents
    Area Under Curve
    Cohort Studies
    Critical Care
    Critical Illness
    Dose-Response Relationship, Drug
    Female
    Half-Life
    Humans
    Kidney
    Kidney Function Tests
    Male
    Methicillin-Resistant Staphylococcus aureus
    Middle Aged
    Pneumonia, Staphylococcal
    Prospective Studies
    Treatment Failure
    Treatment Outcome
    Vancomycin
    Young Adult

    Pub Type(s)

    Journal Article

    Language

    eng

    PubMed ID

    22165354

    Citation

    TY - JOUR T1 - Optimal dose of vancomycin for treating methicillin-resistant Staphylococcus aureus pneumonia in critically ill patients. AU - Chung,J, AU - Oh,J M, AU - Cho,E M, AU - Jang,H J, AU - Hong,S B, AU - Lim,C M, AU - Koh,Y S, PY - 2011/12/15/entrez PY - 2011/12/15/pubmed PY - 2012/1/4/medline SP - 1030 EP - 7 JF - Anaesthesia and intensive care JO - Anaesth Intensive Care VL - 39 IS - 6 N2 - A prospective cohort study was performed to determine the optimal dose of vancomycin to maintain a serum trough concentration of at least 15 to 20 mg/l and to assess the efficacy of this target vancomycin concentration in the treatment of methicillin-resistant Staphylococcus aureus pneumonia. Vancomycin pharmacokinetic parameters were estimated using a CAPSIL software program from serum concentrations of 141 patients with pneumonia treated with vancomycin, regardless of methicillin-resistant Staphylococcus aureus status, at a 28-bed medical intensive care unit. Vancomycin trough concentrations and other pharmacokinetic parameters were compared between five groups of patients differing in their renal function: (1) creatinine clearance > or =60 ml/minute, (2) creatinine clearance 30 to 60 ml/minute, (3) creatinine clearance <30 ml/minute, (4) on intermittent haemodialysis, and (5) on continuous renal replacement therapy. More than 70% of patients failed to reach the recommended therapeutic serum trough concentrations: a higher dose of vancomycin is necessary to maintain serum trough concentration at 15 to 20 mg/l, particularly in critically ill patients with creatinine clearance above 60 ml/minute and in those on intermittent haemodialysis. Among patients with methicillin-resistant Staphylococcus aureus pneumonia, no significant differences were observed in the treatment success rate, length of intensive care unit stay, and intensive care unit mortality rate between patients with vancomycin trough concentrations of >20 mg/l, 15 to 20 mg/l and <15 mg/l. SN - 0310-057X UR - https://www.unboundmedicine.com/medline/citation/22165354/abstract/Optimal_dose_of_vancomycin_for_treating_methicillin_resistant_Staphylococcus_aureus_pneumonia_in_critically_ill_patients_ L2 - http://www.aaic.net.au/PMID/22165354 ER -