Outcome Assessment of Minimizing Vancomycin Monitoring and Dosing Adjustments

  title={Outcome Assessment of Minimizing Vancomycin Monitoring and Dosing Adjustments},
  author={Christine M. Karam and Peggy S. McKinnon and Melinda M. Neuhauser and Michael Joseph Rybak},
  journal={Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy},
An approach to minimize monitoring of vancomycin therapy was evaluated in 120 patients, and results were compared with data from 120 patients in whom vancomycin therapy was monitored and adjusted based on serum peak and trough concentrations and traditional pharmacokinetic methods. Patients dosed by the nomogram (NM) had regimens adjusted based on actual body weight, estimated creatinine clearance, and a targeted trough concentration of 5–20 μg/ml. A single trough serum concentration was drawn… 

[Therapeutic monitoring of vancomycin in critical care pediatric patients].

D dosage regime of vancomycin in patients from a pediatric intensive care unit, register values of plasmatic concentrations and determine the regimes necessary to reach therapeutic troughs are described, being able to suppose that equal schemes of administration could be implemented more frequently.

Evaluation of Treatment Courses When Vancomycin Is Given Every 8 Hours in Adult Patients

An increase in the percentage of trough levels >20 mg/L later during treatment courses of vancomycin IV Q8H with a relatively small corresponding increase in vancomYcin dose is observed.

Evaluation of Vancomycin Dosing and Monitoring in Adult Medicine Patients

The implementation of a vancomycin empiric dosing protocol and monitoring tool had a significant impact on the initial dose, dosing interval, and trough concentrations in adult medicine patients.

Vancomycin Dosing and Monitoring: Critical Evaluation of the Current Practice

  • F. Elbarbry
  • Medicine, Biology
    European Journal of Drug Metabolism and Pharmacokinetics
  • 2017
Two user-friendly and scientifically based dosing strategies are proposed to improve the efficiency of vancomycin dosing while avoiding the risk of nephrotoxicity and minimizing the cost of therapeutic drug monitoring.

Approaching and analyzing a large literature on vancomycin monitoring and pharmacokinetics.

Existing evidence does not seem to support routine serum therapeutic monitoring for vancomycin dosing to improve clinical outcome in patients with sufficient creatinine clearance, however, regular monitoring to allow for dose adjustment in Patients with renal dysfunction and those receiving other nephrotoxic agents is currently recommended due to the potential side effects of excessive vancomYcin dosed in this population subset.

Optimisation of Vancomycin Regimen in Neutropenic Haematological Patients with Normal Renal Function

Since the volume of distribution and/or clearance of vancomycin can be increased in patients with haematological malignancies and normal renal function, increasing the number of daily doses from two to four (with the same total daily dose) may increase t > MIC, an important determinant of van comycin efficacy.

Hospitalized Patients With and Without Hemodialysis Have Markedly Different Vancomycin Pharmacokinetics: A Population Pharmacokinetic Model-Based Analysis

Dosing nomogram based on these covariate relationships may potentially help in accurate dosing of vancomycin.

Evaluation of a vancomycin dosing nomogram in achieving high target trough concentrations in Taiwanese patients.

Development and evaluation of vancomycin dosage guidelines designed to achieve new target concentrations.

New vancomycin dosage guidelines have been developed that achieve trough concentrations of 10-15 mg/L earlier and more consistently than current guidelines.

Recommendations for Monitoring Serum Vancomycin Concentrations

The available evidence on the efficacy and toxicity of different concentrations of vancomycin is examined and guidelines for therapeutic drug monitoring in patients receiving vancomYcin therapy are presented.



A Simplified Dosing Method for Initiating Vancomycin Therapy

A simplified method for initiating vancomycin therapy was developed and evaluated prospectively in 30 patients and resulted in desired serum levels and required no modification in 25 of 30 patients.

Vancomycin pharmacokinetics in critically ill patients.

Tubular damage in critically ill patients with severe sepsis may explain the results of the decreased vancomycin elimination.

Individualized Adjustment of Vancomycin Dosage: Comparison with Two Dosage Nomograms

Overall, the Moellering nomogram was the least accurate of the three methods in predicting vancomycin serum concentrations, and this nomogram should not be used to titrate vancomYcin dosages in a clinical setting.

Association of Vancomycin Serum Concentrations With Outcomes in Patients With Gram‐Positive Bacteremia

The results suggest that the commonly accepted therapeutic range for vancomycin trough concentrations (<10 μg/ml) may be too restrictive in patients receiving vancomYcin therapy alone.

Pharmacokinetics of vancomycin in patients with various degrees of renal function

The pharmacokinetics of vancomycin were characterized in 56 patients with different degrees of renal function after an intravenous dose of 18.4 +/- 4.7 mg kg-1 and the observed relationship between CLS and CLCR can be utilized to devise dosage schedules for patients with any degree of renal impairment.

Vancomycin Pharmacokinetics in a Patient Population: Effect of Age, Gender, and Body Weight

Regression analysis indicated that V was more predictable in women than in men and that vancomycin distributed into excess body weight (EBW) to a greater extent in women, and dosing of vancomYcin may be improved by adjusting initial estimates of V for patient age, gender, and obesity.

Vancomycin pharmacokinetics in patients with various degrees of renal function

The influence of age, protein binding, and renal function on the pharmacokinetics of intravenous vancomycin was evaluated in 37 adult patients with various degrees of renal function and it was found that age did not significantly improve these correlations once CLCR was included.

Serum vancomycin concentrations: reappraisal of their clinical value.

Despite many case reports of vancomycin-associated nephrotoxicity and ototoxicity, it is unclear whether this agent truly causes such conditions, and there is no evidence that adherence to specific ranges of van comycin concentrations will preclude these events.

Vancomycin pharmacokinetics in burn patients and intravenous drug abusers.

Burn patients had a significantly higher creatinine clearance than did IVDA or controls, and further work with IVDA will be needed to determine if they represent a group requiring aggressive vancomycin dosages.

Nephrotoxicity of vancomycin, alone and with an aminoglycoside.

Although the incidence of vancomycin nephrotoxicity is low, patients receiving vancomYcin therapy with the above risk factors should be closely monitored.