Allometric versus consensus guideline dosing in achieving target vancomycin trough concentrations
| Autor: | Matthew L. Brown, Aaron M. McAtee, Darrell T. Childress, Amber M. Hutchison, Philippe Gaillard |
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| Rok vydání: | 2017 |
| Předmět: |
0301 basic medicine
Adult Male medicine.medical_specialty Consensus 030106 microbiology Urology Pharmacology Nephrotoxicity 03 medical and health sciences 0302 clinical medicine Pharmacokinetics Vancomycin Medicine Body Size Humans Trough Concentration 030212 general & internal medicine Dosing Obesity Infusions Intravenous Aged Retrospective Studies Dose-Response Relationship Drug business.industry Health Policy Body Weight Retrospective cohort study Guideline Middle Aged Anti-Bacterial Agents Hospitalization Practice Guidelines as Topic Female Allometry business medicine.drug |
| Zdroj: | American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists. 74(14) |
| ISSN: | 1535-2900 |
| Popis: | Purpose Results of a study comparing the performance of allometric versus consensus guideline–recommended vancomycin dosing in achieving initial trough concentrations within the desired range are reported. Methods A retrospective study was conducted to compare selected outcomes with 2 vancomycin dosing methods: (1) dosing by total body weight, as recommended in current consensus guidelines, and (2) a new empirical vancomycin dosing strategy grounded in allometry (the study of the relationship between body size and physiology). The primary outcome was attainment of an initial vancomycin trough concentration within the target range (10–20 mg/L). Rates of nephrotoxicity associated with the 2 dosing methods were compared. Results Allometric dosing resulted in 77% of the evaluated patient sample ( n = 81) achieving vancomycin trough concentration targets at the initial measurement, as compared with a target attainment rate of 57% ( n = 81) with guideline-recommended dosing ( p = 0.0121); the rate of target attainment in obese patients was also improved with allometric dosing (73% versus 46%, p = 0.0327). Nephrotoxicity rates did not differ significantly between the 2 groups, but a lower rate was observed with allometric versus guideline-based dosing (1.2% versus 7.4%, p = 0.0584). Conclusion In hospitalized adults, allometric vancomycin dosing achieved a higher frequency of initial vancomycin trough concentrations within the target range of 10–20 mg/L, compared with dosing as recommended by consensus guidelines. The difference between methods in the percentage of troughs within the target range was most pronounced in obese patients. |
| Databáze: | OpenAIRE |
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