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2016 ; 60
(5
): 2601-9
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Optimizing the Clinical Use of Vancomycin
#MMPMID26856841
Álvarez R
; López Cortés LE
; Molina J
; Cisneros JM
; Pachón J
Antimicrob Agents Chemother
2016[May]; 60
(5
): 2601-9
PMID26856841
show ga
The increasing number of infections produced by beta-lactam-resistant
Gram-positive bacteria and the morbidity secondary to these infections make it
necessary to optimize the use of vancomycin. In 2009, the American Society of
Health-System Pharmacists, the Infectious Diseases Society of America, and the
Society of Infectious Disease Pharmacists published specific guidelines about
vancomycin dosage and monitoring. However, these guidelines have not been updated
in the past 6 years. This review analyzes the new available information about
vancomycin published in recent years regarding pharmacokinetics and
pharmacodynamics, serum concentration monitoring, and optimal vancomycin dosing
in special situations (obese people, burn patients, renal replacement therapy,
among others). Vancomycin efficacy is linked to a correct dosage which should aim
to reach an area under the curve (AUC)/MIC ratio of ?400; serum trough levels of
15 to 20 mg/liter are considered a surrogate marker of an AUC/MIC ratio of ?400
for a MIC of ?1 mg/liter. For Staphylococcus aureus strains presenting with a MIC
>1 mg/liter, an alternative agent should be considered. Vancomycin doses must be
adjusted according to body weight and the plasma trough levels of the drug.
Nephrotoxicity has been associated with target vancomycin trough levels above 15
mg/liter. Continuous infusion is an option, especially for patients at high risk
of renal impairment or unstable vancomycin clearance. In such cases, vancomycin
plasma steady-state level and creatinine monitoring are strongly indicated.
|Anti-Bacterial Agents/administration & dosage/blood/pharmacokinetics/therapeutic
use
[MESH]
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