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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
A new regimen for continuous infusion of vancomycin during continuous renal replacement therapy
Journal of Antimicrobial Chemotherapy, Volume 68, No. 12, Article dkt261, Year 2013
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Description
Introduction: Continuous infusion (CI) of high-dose vancomycin is often used to treat life-threatening infections caused by less-susceptible Gram-positive bacteria. However, this approach has not been well studied in patients on continuous renal replacement therapy (CRRT). The aim of this study was to evaluate the adequacy of a new CI vancomycin regimen in septic patients undergoing CRRT. Methods: In this prospective study we measured vancomycin concentrations obtained with a new CI regimen for CRRT, which included a loading dose of 35 mg/kg given over a 4 h period followed by a daily dose of 14 mg/kg. Vancomycin concentrations were measured: at the end of the loading dose (T1); 12 h after the onset of therapy (T2); and 24 h after the onset of therapy (T3). Drug concentrations (at T2 and T3) were considered adequate if between 20 and 30 mg/L. CRRT intensity was calculated as: dialysate rate (mL/kg/h)+ultrafiltration rate (mL/kg/h). Vancomycin population pharmacokinetics were calculated using non-linear mixed-effects modelling. Results: We studied 32 patients who received median (IQR) loading and daily vancomycin doses of 2750 mg (2250-3150) and 1100 mg (975-1270), respectively. Drug concentrations were: T1, 44 mg/L (38-58); T2, 27 mg/L (24-31); and T3, 23 mg/L (19-31). Vancomycin concentrations were adequate in 22/32 patients (69%) at T2 and in 20/32 (63%) at T3. The two relevant covariates that significantly affected drug concentrations were body weight and CRRT intensity. Conclusions: This new vancomycin regimen allowed the rapid achievement of target drug concentrations in the majority of patients. CRRT intensity had an influence on vancomycin clearance. © The Author 2013. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved.
Authors & Co-Authors
Roberts, Jason A.
Australia, Brisbane
The University of Queensland
Hites, Maya
Belgium, Brussels
Université Libre de Bruxelles
Cotton, Frédéric
Belgium, Brussels
Université Libre de Bruxelles
Lipman, Jeffrey
Australia, Brisbane
The University of Queensland
Jacobs, Frédérique
Belgium, Brussels
Université Libre de Bruxelles
Vincent, Jean Louis
Belgium, Brussels
Université Libre de Bruxelles
Taccone, Fabio Silvio S.
Belgium, Brussels
Université Libre de Bruxelles
Statistics
Citations: 52
Authors: 7
Affiliations: 2
Identifiers
Doi:
10.1093/jac/dkt261
ISSN:
14602091
Research Areas
Cancer
Study Design
Cross Sectional Study
Cohort Study