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Does vancomycin trough concentration useful to predict optimal dosing during continuous venovenous haemofiltration? Preliminary findings from the valley study

Introduction: Achieving optimal vancomycin dosing, particularly in septic critically ill patients receiving continuous renal replacement therapy (CRRT) is crucial. Established guidelines recommend the use of trough concentrations to manage vancomycin dosing in adult patients with gram-positive infec...

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Main Authors: Mohamad Nor, Fariz Safhan, Jamal, Janattul-Ain, Mohd Samat, Noryani, Ahmad, Mohd Kamil, Wan Ali, Wan Ahmad Syahril Rozli, Che Wan, Mohd Hafiz
Format: Article
Language:English
Published: Science Direct 2017
Subjects:
RC Internal medicine
Online Access:http://irep.iium.edu.my/58925/1/PIIS2468024917302875.pdf
http://irep.iium.edu.my/58925/
http://www.sciencedirect.com/science/article/pii/S2468024917302875
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spelling my.iium.irep.589252018-03-12T03:09:37Z http://irep.iium.edu.my/58925/ Does vancomycin trough concentration useful to predict optimal dosing during continuous venovenous haemofiltration? Preliminary findings from the valley study Mohamad Nor, Fariz Safhan Jamal, Janattul-Ain Mohd Samat, Noryani Ahmad, Mohd Kamil Wan Ali, Wan Ahmad Syahril Rozli Che Wan, Mohd Hafiz RC Internal medicine Introduction: Achieving optimal vancomycin dosing, particularly in septic critically ill patients receiving continuous renal replacement therapy (CRRT) is crucial. Established guidelines recommend the use of trough concentrations to manage vancomycin dosing in adult patients with gram-positive infections. Importantly, obtaining the area under the plasma concentration-time curve (AUC), based on the pharmacokinetic / pharmacodynamics (PK/PD) concept, is extremely required. Objective: This study aimed to describe the pharmacokinetics (PK) of vancomycin in Malaysian critically ill patients receiving CRRT, and the achievement of its therapeutic target, the ratio of the AUC to the minimum inhibitory concentration (MIC) of causative pathogen (AUC/ MIC >400), using a standard dosing regimen (750 mg 12 hourly). Methodology: This was a prospective PK study of vancomycin using standard dosing regimen, in critically ill patients receiving continuous venovenous haemofiltration (CVVH). Blood samples were collected at ten sampling times during a dosing interval. PK analyses were evalu- ated using non-compartmental method. Vancomycin trough concen- trations (15-20 mg/L), and the achievement of the ratio of AUC/ MIC>400, based on selected susceptibility breakpoint (MIC1⁄41 mg/L), were evaluated. Results: Fifty blood samples from five PK profiles of five patients were analysed. The median (interquartile range) of vancomycin total clear- ance (CLtotal) and volume of distribution (Vd) were 62.8 (45.1-62.7) mL/ min and 62.0 (48.7-94.2) L respectively, during CVVH. Maximum concentration, Cmax[30.8 (30.5-33.2) mg/L] was observed at 1.8`0.3 h. The standard dosing regimen (750 mg 12 hourly) resulted in AUC0-24 and Cmin of 400.1 (399.0-504.1) mg.h/L and 12.1 (10.7-16.1) mg/L, respectively. Of these, only two patients, who were anuric, obtained trough concentration between 15-20 mg/L and subsequently achieved the targeted AUC/MIC>400 (MIC1⁄41 mg/L). Conclusion: Obtaining trough concentration between 15-20 mg/L rela- tively achieved the desired AUC/MIC >400 for vancomycin during CVVH. Higher trough concentration (e.g 20-25 mg/L) may be required when targeting for a higher MIC (e.g >1mg/L). Initiation of a higher dosing regimen could also be necessary, particularly in patients undergoing CVVH with significant residual native renal function. Further data is required, from continuation of this study, to clarify the findings. Science Direct 2017-08 Article REM application/pdf en http://irep.iium.edu.my/58925/1/PIIS2468024917302875.pdf Mohamad Nor, Fariz Safhan and Jamal, Janattul-Ain and Mohd Samat, Noryani and Ahmad, Mohd Kamil and Wan Ali, Wan Ahmad Syahril Rozli and Che Wan, Mohd Hafiz (2017) Does vancomycin trough concentration useful to predict optimal dosing during continuous venovenous haemofiltration? Preliminary findings from the valley study. Kidney International Reports, 2 (4, supp.1). S38-S39. ISSN 2468-0249 http://www.sciencedirect.com/science/article/pii/S2468024917302875 doi.org/10.1016/j.ekir.2017.06.123
institution Universiti Islam Antarabangsa Malaysia
building IIUM Library
collection Institutional Repository
continent Asia
country Malaysia
content_provider International Islamic University Malaysia
content_source IIUM Repository (IREP)
url_provider http://irep.iium.edu.my/
language English
topic RC Internal medicine
spellingShingle RC Internal medicine
Mohamad Nor, Fariz Safhan
Jamal, Janattul-Ain
Mohd Samat, Noryani
Ahmad, Mohd Kamil
Wan Ali, Wan Ahmad Syahril Rozli
Che Wan, Mohd Hafiz
Does vancomycin trough concentration useful to predict optimal dosing during continuous venovenous haemofiltration? Preliminary findings from the valley study
description Introduction: Achieving optimal vancomycin dosing, particularly in septic critically ill patients receiving continuous renal replacement therapy (CRRT) is crucial. Established guidelines recommend the use of trough concentrations to manage vancomycin dosing in adult patients with gram-positive infections. Importantly, obtaining the area under the plasma concentration-time curve (AUC), based on the pharmacokinetic / pharmacodynamics (PK/PD) concept, is extremely required. Objective: This study aimed to describe the pharmacokinetics (PK) of vancomycin in Malaysian critically ill patients receiving CRRT, and the achievement of its therapeutic target, the ratio of the AUC to the minimum inhibitory concentration (MIC) of causative pathogen (AUC/ MIC >400), using a standard dosing regimen (750 mg 12 hourly). Methodology: This was a prospective PK study of vancomycin using standard dosing regimen, in critically ill patients receiving continuous venovenous haemofiltration (CVVH). Blood samples were collected at ten sampling times during a dosing interval. PK analyses were evalu- ated using non-compartmental method. Vancomycin trough concen- trations (15-20 mg/L), and the achievement of the ratio of AUC/ MIC>400, based on selected susceptibility breakpoint (MIC1⁄41 mg/L), were evaluated. Results: Fifty blood samples from five PK profiles of five patients were analysed. The median (interquartile range) of vancomycin total clear- ance (CLtotal) and volume of distribution (Vd) were 62.8 (45.1-62.7) mL/ min and 62.0 (48.7-94.2) L respectively, during CVVH. Maximum concentration, Cmax[30.8 (30.5-33.2) mg/L] was observed at 1.8`0.3 h. The standard dosing regimen (750 mg 12 hourly) resulted in AUC0-24 and Cmin of 400.1 (399.0-504.1) mg.h/L and 12.1 (10.7-16.1) mg/L, respectively. Of these, only two patients, who were anuric, obtained trough concentration between 15-20 mg/L and subsequently achieved the targeted AUC/MIC>400 (MIC1⁄41 mg/L). Conclusion: Obtaining trough concentration between 15-20 mg/L rela- tively achieved the desired AUC/MIC >400 for vancomycin during CVVH. Higher trough concentration (e.g 20-25 mg/L) may be required when targeting for a higher MIC (e.g >1mg/L). Initiation of a higher dosing regimen could also be necessary, particularly in patients undergoing CVVH with significant residual native renal function. Further data is required, from continuation of this study, to clarify the findings.
format Article
author Mohamad Nor, Fariz Safhan
Jamal, Janattul-Ain
Mohd Samat, Noryani
Ahmad, Mohd Kamil
Wan Ali, Wan Ahmad Syahril Rozli
Che Wan, Mohd Hafiz
author_facet Mohamad Nor, Fariz Safhan
Jamal, Janattul-Ain
Mohd Samat, Noryani
Ahmad, Mohd Kamil
Wan Ali, Wan Ahmad Syahril Rozli
Che Wan, Mohd Hafiz
author_sort Mohamad Nor, Fariz Safhan
title Does vancomycin trough concentration useful to predict optimal dosing during continuous venovenous haemofiltration? Preliminary findings from the valley study
title_short Does vancomycin trough concentration useful to predict optimal dosing during continuous venovenous haemofiltration? Preliminary findings from the valley study
title_full Does vancomycin trough concentration useful to predict optimal dosing during continuous venovenous haemofiltration? Preliminary findings from the valley study
title_fullStr Does vancomycin trough concentration useful to predict optimal dosing during continuous venovenous haemofiltration? Preliminary findings from the valley study
title_full_unstemmed Does vancomycin trough concentration useful to predict optimal dosing during continuous venovenous haemofiltration? Preliminary findings from the valley study
title_sort does vancomycin trough concentration useful to predict optimal dosing during continuous venovenous haemofiltration? preliminary findings from the valley study
publisher Science Direct
publishDate 2017
url http://irep.iium.edu.my/58925/1/PIIS2468024917302875.pdf
http://irep.iium.edu.my/58925/
http://www.sciencedirect.com/science/article/pii/S2468024917302875
_version_ 1643615470282080256
score 13.211869

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