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Achievement of Vancomycin Therapeutic Goals in Critically Ill Patients: Early Individualization may be Beneficial


Affiliations
1 Clinical Pharmacy Department, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran 14155/6451, Iran, Islamic Republic of
2 Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmacy and Pharmaceutical Sciences, Isfahan University of Medical Sciences, Isfahan 71746-73461, Iran, Islamic Republic of
3 Anesthesiology and Intensive Care Department, School of Medicine, Tehran University of Medical Sciences, Tehran 14155/6451, Iran, Islamic Republic of
4 Department of Pharmaceutics, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran 14155/6451, Iran, Islamic Republic of
 

Objective: The aim of our study was to assess and validate the effectiveness of early dose adjustment of vancomycin based on first dose monitoring in achieving target recommended goal in critically ill patients. Methods: Twenty critically ill patients with sepsis received loading dose of 25mg/kg of vancomycin and then were randomly assigned to 2 groups. Group 1 receivedmaximum empirical doses of vancomycin of 15mg/kg every 8 hrs. In group 2, the doses were individualized based on serum concentrations of vancomycin. First dose nonsteady state sampling was used to calculate pharmacokinetic parameters of the patients within 24 hours. Results: Steady state trough serum concentrations were significantly higher in group 2 in comparison with group 1 (19.4 ± 4.4mg/L versus 14.4 ± 4.3mg/L) (P = 0.03). Steady state AUCs were significantly higher in group 2 compared with group 1 (665.9 ± 136.5mg·hr/L versus 490.7 ± 101.1mg·hr/L) (P = 0.008). Conclusions: With early individualized dosing regimen, significantly more patients achieved peak and trough steady state concentrations. In the context of pharmacokinetic/pharmacodynamic goal of area under the time concentration curve to minimum inhibitory concentration (AUC/MIC) ≥400 and also to obtain trough serum concentration of vancomycin of ≥15mg/L, it is necessary to individualize doses of vancomycin in critically ill patients.
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  • Achievement of Vancomycin Therapeutic Goals in Critically Ill Patients: Early Individualization may be Beneficial

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Authors

Bita Shahrami
Clinical Pharmacy Department, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran 14155/6451, Iran, Islamic Republic of
Farhad Najmeddin
Clinical Pharmacy Department, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran 14155/6451, Iran, Islamic Republic of
Sarah Mousavi
Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmacy and Pharmaceutical Sciences, Isfahan University of Medical Sciences, Isfahan 71746-73461, Iran, Islamic Republic of
Arezoo Ahmadi
Anesthesiology and Intensive Care Department, School of Medicine, Tehran University of Medical Sciences, Tehran 14155/6451, Iran, Islamic Republic of
Mohammad Reza Rouini
Department of Pharmaceutics, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran 14155/6451, Iran, Islamic Republic of
Kourosh Sadeghi
Clinical Pharmacy Department, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran 14155/6451, Iran, Islamic Republic of
Mojtaba Mojtahedzadeh
Clinical Pharmacy Department, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran 14155/6451, Iran, Islamic Republic of

Abstract


Objective: The aim of our study was to assess and validate the effectiveness of early dose adjustment of vancomycin based on first dose monitoring in achieving target recommended goal in critically ill patients. Methods: Twenty critically ill patients with sepsis received loading dose of 25mg/kg of vancomycin and then were randomly assigned to 2 groups. Group 1 receivedmaximum empirical doses of vancomycin of 15mg/kg every 8 hrs. In group 2, the doses were individualized based on serum concentrations of vancomycin. First dose nonsteady state sampling was used to calculate pharmacokinetic parameters of the patients within 24 hours. Results: Steady state trough serum concentrations were significantly higher in group 2 in comparison with group 1 (19.4 ± 4.4mg/L versus 14.4 ± 4.3mg/L) (P = 0.03). Steady state AUCs were significantly higher in group 2 compared with group 1 (665.9 ± 136.5mg·hr/L versus 490.7 ± 101.1mg·hr/L) (P = 0.008). Conclusions: With early individualized dosing regimen, significantly more patients achieved peak and trough steady state concentrations. In the context of pharmacokinetic/pharmacodynamic goal of area under the time concentration curve to minimum inhibitory concentration (AUC/MIC) ≥400 and also to obtain trough serum concentration of vancomycin of ≥15mg/L, it is necessary to individualize doses of vancomycin in critically ill patients.