Tags

Type your tag names separated by a space and hit enter

Vancomycin volume of distribution estimation in adults with class III obesity.
Am J Health Syst Pharm 2019; 76(24):2013-2018AJ

Abstract

PURPOSE

To compare methods of estimating vancomycin volume of distribution (V) in adults with class III obesity.

METHODS

A retrospective, multicenter pharmacokinetic analysis of adults treated with vancomycin and monitored through measurement of peak and trough concentrations was performed. Individual pharmacokinetic parameter estimates were obtained via maximum a posteriori Bayesian analysis. The relationship between V and body weight was assessed using linear regression. Mean bias and root-mean-square error (RMSE) were calculated to assess the precision of multiple methods of estimating V.

RESULTS

Of 241 patients included in the study sample, 159 (66.0%) had a body mass index (BMI) of 40.0-49.9 kg/m2, and 82 (34.0%) had a BMI of ≥50.0 kg/m2. The median (5th, 95th percentile) weight of patients was 136 (103, 204) kg, and baseline characteristics were similar between BMI groups. The mean ± S.D. V was lower in patients with a BMI of 40.0-49.9 kg/m2 than in those with a BMI of ≥50.0 kg/m2 (72.4 ± 19.6 L versus 79.3 ± 20.6 L, p = 0.009); however, body size poorly predicted V in regression analyses (R2 < 0.20). A fixed estimate of V (75 L) and use of a weight-based value (0.52 L/kg by total body weight [TBW]) yielded similar bias and error in this population.

CONCLUSION

Results of the largest analysis of vancomycin V in class III obesity to date indicated that use of a fixed V value (75 L) and use of a TBW-based estimate (0.52 L/kg) for estimation of vancomycin V in patients with a BMI of ≥40.0 kg/m2 have similar bias. Two postdistribution vancomycin concentrations are needed to accurately determine patient-specific pharmacokinetic parameters, estimate area under the curve, and improve the precision of vancomycin dosing in this patient population.

Authors+Show Affiliations

Department of Pharmacy, Morton Plant Hospital, BayCare Health System, Clearwater, FL.Department of Clinical Pharmacy, College of Pharmacy, University of Michigan, Ann Arbor, MI.Department of Pharmacy, Morton Plant Hospital, BayCare Health System, Clearwater, FL.Department of Clinical Pharmacy, College of Pharmacy, University of Michigan, Ann Arbor, MI.Department of Pharmacy, Morton Plant Hospital, BayCare Health System, Clearwater, FL.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31630155

Citation

Dunn, Ryan D., et al. "Vancomycin Volume of Distribution Estimation in Adults With Class III Obesity." American Journal of Health-system Pharmacy : AJHP : Official Journal of the American Society of Health-System Pharmacists, vol. 76, no. 24, 2019, pp. 2013-2018.
Dunn RD, Crass RL, Hong J, et al. Vancomycin volume of distribution estimation in adults with class III obesity. Am J Health Syst Pharm. 2019;76(24):2013-2018.
Dunn, R. D., Crass, R. L., Hong, J., Pai, M. P., & Krop, L. C. (2019). Vancomycin volume of distribution estimation in adults with class III obesity. American Journal of Health-system Pharmacy : AJHP : Official Journal of the American Society of Health-System Pharmacists, 76(24), pp. 2013-2018. doi:10.1093/ajhp/zxz241.
Dunn RD, et al. Vancomycin Volume of Distribution Estimation in Adults With Class III Obesity. Am J Health Syst Pharm. 2019 Dec 2;76(24):2013-2018. PubMed PMID: 31630155.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Vancomycin volume of distribution estimation in adults with class III obesity. AU - Dunn,Ryan D, AU - Crass,Ryan L, AU - Hong,Joseph, AU - Pai,Manjunath P, AU - Krop,Lynne C, PY - 2019/10/21/pubmed PY - 2019/10/21/medline PY - 2019/10/21/entrez KW - Bayesian KW - body mass index KW - glycopeptide KW - morbid obesity KW - pharmacokinetics KW - vancomycin administration and dosage SP - 2013 EP - 2018 JF - American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists JO - Am J Health Syst Pharm VL - 76 IS - 24 N2 - PURPOSE: To compare methods of estimating vancomycin volume of distribution (V) in adults with class III obesity. METHODS: A retrospective, multicenter pharmacokinetic analysis of adults treated with vancomycin and monitored through measurement of peak and trough concentrations was performed. Individual pharmacokinetic parameter estimates were obtained via maximum a posteriori Bayesian analysis. The relationship between V and body weight was assessed using linear regression. Mean bias and root-mean-square error (RMSE) were calculated to assess the precision of multiple methods of estimating V. RESULTS: Of 241 patients included in the study sample, 159 (66.0%) had a body mass index (BMI) of 40.0-49.9 kg/m2, and 82 (34.0%) had a BMI of ≥50.0 kg/m2. The median (5th, 95th percentile) weight of patients was 136 (103, 204) kg, and baseline characteristics were similar between BMI groups. The mean ± S.D. V was lower in patients with a BMI of 40.0-49.9 kg/m2 than in those with a BMI of ≥50.0 kg/m2 (72.4 ± 19.6 L versus 79.3 ± 20.6 L, p = 0.009); however, body size poorly predicted V in regression analyses (R2 < 0.20). A fixed estimate of V (75 L) and use of a weight-based value (0.52 L/kg by total body weight [TBW]) yielded similar bias and error in this population. CONCLUSION: Results of the largest analysis of vancomycin V in class III obesity to date indicated that use of a fixed V value (75 L) and use of a TBW-based estimate (0.52 L/kg) for estimation of vancomycin V in patients with a BMI of ≥40.0 kg/m2 have similar bias. Two postdistribution vancomycin concentrations are needed to accurately determine patient-specific pharmacokinetic parameters, estimate area under the curve, and improve the precision of vancomycin dosing in this patient population. SN - 1535-2900 UR - https://www.unboundmedicine.com/medline/citation/31630155/Vancomycin_volume_of_distribution_estimation_in_adults_with_class_III_obesity L2 - https://academic.oup.com/ajhp/article-lookup/doi/10.1093/ajhp/zxz241 DB - PRIME DP - Unbound Medicine ER -