Evaluation of a New Vancomycin Dosing Protocol in Morbidly Obese Patients.
| Autor: | Kosmisky, Desiree E., Griffiths, Carrie L., Templin, Megan A., Norton, James, Martin, Kelly E. |
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| Předmět: |
INFECTION prevention
PNEUMONIA treatment STAPHYLOCOCCAL disease treatment NEUTROPENIA CELLULITIS DRUG monitoring DOSAGE forms of drugs CLINICAL drug trials DRUG toxicity FISHER exact test GENETIC techniques INTENSIVE care units MEDICAL care MEDICAL protocols MEDICAL societies MENINGITIS OSTEOMYELITIS PATIENTS PHARMACOLOGY SEPSIS STATISTICS T-test (Statistics) URINARY tract infections COMORBIDITY VANCOMYCIN DATA analysis MORBID obesity TREATMENT effectiveness ACQUISITION of data RETROSPECTIVE studies PATIENT selection METHICILLIN-resistant staphylococcus aureus THERAPEUTICS |
| Zdroj: | Hospital Pharmacy; Oct2015, Vol. 50 Issue 9, p789-797, 9p |
| Abstrakt: | Background: Optimal dosing of vancomycin in morbidly obese patients (>100 kg and at least 140% of their ideal body weight) has not been determined. Conventional dosing strategies have led to the observation of supratherapeutic trough concentrations (>20 mcg/mL). Objective: To evaluate the effectiveness of a new vancomycin dosing protocol in morbidly obese patients in achieving therapeutic trough concentrations between 10 and 20 mcg/mL and to determine patient-specific factors influencing the trough concentration attained. Methodology: A single-center, retrospective chart review included morbidly obese adult patients with a pharmacy-to-dose vancomycin consult and at least 1 trough concentration obtained at steady state. Patients were excluded if they had a creatinine clearance (CrCl) less than 35 mL/min or unstable renal function, were not dosed according to the revised protocol, or received vancomycin prior to initiation of the protocol. Results: Of the 48 patients included, 17 (35.4%) achieved a therapeutic vancomycin trough concentration. Subtherapeutic concentrations (<10 mcg/mL) were observed in 27 patients (56.3%) and supratherapeutic concentrations were observed in 4 (8.3%) patients. Age less than 45 years and CrCl greater than 100 mL/min were associated with subtherapeutic trough concentrations. Conclusion: This study demonstrates that the revised vancomycin dosing protocol led to the attainment of therapeutic trough concentrations in 35.4% of patients. The majority had subtherapeutic concentrations, which increases the risk of treatment failures and resistance. Further study is needed to determine the optimal dosing strategy in this patient population. [ABSTRACT FROM AUTHOR] |
| Databáze: | Complementary Index |
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