Pharmacokinetic/pharmacodynamic analysis of vancomycin in ICU patients |
| |
Authors: | Maria del Mar Fernández de Gatta Garcia Natalia Revilla Maria Victoria Calvo Alfonso Domínguez-Gil Amparo Sánchez Navarro |
| |
Institution: | (1) Pharmacy Department, University of Salamanca, Salamanca, Spain;(2) University Hospital of Salamanca, Salamanca, Spain |
| |
Abstract: | Aims To identify the variables affecting vancomycin pharmacokinetics in medical ICU patients and to evaluate the potential efficacy
of dosage schedules by PK/PD analysis.
Design A retrospective pharmacokinetic analysis of serum levels obtained in routine vancomycin monitoring was performed.
Setting A 12-bed general ICU of a university teaching hospital.
Patients Forty-six vancomycin-treated ICU patients fitting the following criteria: over 18 years old; more than three concentration
data per patient; absence of renal replacement support, cardiac surgery and neoplastic disorders.
Interventions Clinical information was collected from the patients' medical records. Details of vancomycin therapy, dosage and blood sampling
times were obtained from pharmacokinetic reports. Population analysis were made by the standard two-stage approach.
Measurements and main results Vancomycin clearance and distribution volume were estimated individually assuming a one-compartment pharmacokinetic model.
PK/PD analysis was performed by Monte Carlo simulation. In the ICU patients, higher Vd (nearly twice the quoted value of 0.72 l/kg)
and different vancomycin clearance–creatinine clearance relationship were found. Renal function, the APACHE score, age and
serum albumin accounted for more than 65% of drug clearance variability. Vancomycin standard dosages led to a 33% risk of
not achieving the recommended AUC24h/MIC breakpoint for Staphylococcus aureus.
Conclusions The population kinetics and PK/PD analyses based on Monte Carlo simulation procedures offer an excellent tool for selecting
the therapeutic option with the highest probability of clinical success in ICU patients.
Electronic supplementary material Supplementary material is available in the online version of this article at and is accessible for authorized users. |
| |
Keywords: | Vancomycin ICU patients Population kinetics Dosage optimisation PK/PD analysis Monte Carlo simulation |
本文献已被 PubMed SpringerLink 等数据库收录! |
|