Evaluation of the effectiveness of a vancomycin nomogram at. The patients and physicians were unaware of the monitoring. It exerts its bactericidal effect by complexing with the dalanyldalanine portion of the peptide. We wished to determine to what extent faecal levels of vancomycin vary according to diarrhoea severity and dosage, and whether it is rational to administer. Adult patients 18 years or older who were started on vancomycin using the hdvn and had at least one vancomycin trough drawn at steady state between july 2011 and june 2012 were included. Vancomycin utilisation has increased dramatically in the last 10 years due to the increasing clinical significance of infections with methicillinresistant staphylococci. Guidelines for monitoring of vancomycin serum concentrations. The vancomycin dose was based on 15 mg of vancomycin per kilogram of total body weight. Clinical study prospective trial of a novel nomogram to. Vancomycin regional guideline september 27, 2011 2 objectives to provide recommendations for. To determine if the use of a novel vancomycin nomogram predicts dosing regimens that achieve target trough concentrations equal to or more accurate than dosing regimens calculated using. Conversion from vancomycin trough concentrationguided dosing. It has activity against grampositive rods and cocci, gramnegative rods are resistant to its bactericidal action.
Vancomycin therapeutic drug monitoring vancouver coastal. Vancomycin prescribing and therapeutic drug monitoring clinical guideline v6. Target vancomycin serum levels for specific indications and pathogens. Use of ideal body weight ibw for determining the mgkgdose appears to be more accurate than dosing on the basis of total body weight tbw. Validation of the effectiveness of a vancomycin nomogram. Vancomycin hydrochloride has the following structural formula. The journal of human pharmacology and drug therapy. Cystatin c is a renal biomarker that has been proposed to be used as an alternative to or in conjunction with creatinine for estimating glomerular filtration rate gfr. The results of this study revealed that implementation of a vancomycin nomogram into a cpoe system was associated with an increased percentage of patients with an initial optimal vancomycin. Department of pharmacotherapy and pharmacy services, university. Decreasing the time to achieve therapeutic vancomycin.
Aim for a target of 20 mgl a target of 25 mgl may be used for cns infections. Mediakit reprints and eprints sponsored supplements branded books. Analyze current guideline recommendations for vancomycin dosing and. Annals of pharmacotherapy vancomycin loading doses. Vancomycin is one of only a few antibiotics available to treat patients infected. Evaluation of a vancomycin dosing nomogram in obese. This integrated nomogram is a tool that clinicians can use in selecting appropriate initial vancomycin regimens on the basis of age and serum creatinine, to. A high dose vancomycin nomogram hdvn was developed to recommend a dose and frequency to target troughs of 15 to 20 mgl. Evaluation of a pharmacistdirected vancomycin dosing and monitoring pilot program at a tertiary academic medical center article pdf available in annals of pharmacotherapy 499 may 2015 with.
To determine if the use of a novel vancomycin nomogram predicts dosing regimens that achieve target trough concentrations equal to or more accurate than dosing regimens calculated using traditional pharmacokinetic calculations, evaluate the incidence of subtherapeutic and supratherapeutic troughs, and assess pharmacists impressions of the nomogram. This book is distributed under the terms of the creative commons. An overweight male, 43 years of age, 62 in height and 300 lbs in weight acquired s. Vancomycin is bactericidal and exhibits timedependent or concentrationindependent bacterial killing. For patients in the nontdm group, the pharmacist only completed a data collection form. Evaluation of the effectiveness of a vancomycin nomogram. Prospectively validated dosing nomograms for maximizing. The response to vancomycin was excellent, and the presence of this disease, also called acute staphylococcal ileocolitis, became an indication for the use of vancomycin. Vancomycin trough only retrospective case 2 the above patient was given mg q24h and the trough right before the fifth dose was 11. The authors developed a dosing nomogram that used ckdepicreatininecystatinc based estimated gfr egfrcrcysc as well as the target vancomycin trough level and patient weight. Evaluation of a pharmacistdirected vancomycin dosing and.
Clinical pharmacokinetics of vancomycin springerlink. Evaluation of a high dose vancomycin nomogram and the n. Vancomycin nomogram goal trough 1520 mcgml 45 120 70 65 60 75 100 95 80 85 90 110 115 105 1500 q12 3417 1500 q12 3519 q8 2716 q8 2817 1500 q12. Detroit receiving hospital and university health center. The use of a vancomycin dosing nomogram is an alternative and more costeffective method to conventional dosing. Oral vancomycin 125 mg qid is recommended as treatment of severe clostridium difficile infection cdi. After this, vancomycin levels can be repeated every 3 days or whenever there is a significant change in bodyweight, serum creatinine or if the dose has been adjusted. Two recent studies employed a practical approach to development and implementation of a cystatin cinclusive vancomycin dosing nomogram in clinical. Pharmacistmanaged intravenous iv vancomycin protocol. Validation of the effectiveness of a vancomycin nomogram in achieving target trough concentrations of 1520 mgl suggested by the vancomycin consensus guidelines.
Development and validation of a novel vancomycin dosing. Vancomycin casebook in clinical pharmacokinetics and. Conversion from vancomycin trough concentrationguided dosing to. Generally, the combination of a betalactam antibiotic or vancomycin with either gentamicin or streptomycin is considered to be synergistic in killing the bacterial organism. Laboratory tests to direct antimicrobial pharmacotherapy. Vancomycin routine monitoring should be a single trough level at steady state. Pharmacistled implementation of a vancomycin guideline across medical and surgical units. Jan 01, 2006 vancomycin is a large glycopeptide compound with a molecular weight of. Vancomycin is a glycopeptide antibiotic used to treat severe grampositive. Therapeutic monitoring of vancomycin in critical ill patients.
Two recent studies employed a practical approach to development and implementation of a cystatin cinclusive vancomycin dosing nomogram in clinical practice. Use of ideal body weight ibw for determining the mgkgdose appears to be more accurate than dosing on the basis of total body. December 2011 faqs drug information group university of. Vancomycin is a tricyclic glycopeptide that has gained clinical importance thanks to its effectiveness against organisms such as mrsa and enterococci. Vancomycin pharmacokinetics vary widely between patients.
Iv vancomycin dosing and monitoring antibiotic guidelines. Vancomycin loading doses in ed not associated with increased nephrotoxicity. Pdf prospective trial of a novel nomogram to achieve. Vancomycin regional guideline september 27, 2011 8 appendix 1 dosing recommendations for obese patients the formal definition of obesity is defined as a bmi of 30 or more. Therapeutic monitoring of vancomycin in adults summary of consensus recommendations from the american society of healthsystem pharmacists, the infectious diseases society of america, and the society of infectious diseases pharmacists. Page 1 of 3 detroit receiving hospital and university health center vancomycin dosing nomogram table. Feb 17, 2009 after more than five decades of widespread clinical use, vancomycin may still have a major role in the treatment of multidrugresistant grampositive bacterial infections 18, 23, even though its clinical efficacy for the treatment of deepseated infections is often called into question because of it poor penetration into tissue and its relatively weak antibacterial activity 5, 33. Faecal pharmacokinetics of orally administered vancomycin in. Vancomycin prescribing and therapeutic drug monitoring. Concerning this recommendation, several nomograms have been constructed targeting this optimal trough level range in different populations of patients. Vancomycin nomogram guidelines in a cpoe system medscape. Vancomycin is a glycopeptide antibiotic, approved by the fda in 1958, which is slowly bactericidal against most grampositive organisms. Vancomycin dosing nomograms targeting high serum trough. It is active against staphylococci including penicillin and oxacillinresistant strains, streptococci, enterococci, and other grampositive organisms.
Recent studies have focused on characterising the disposition of vancomycin in patients and assessing the relationship between serum concentrations and therapeutic as well as adverse effects. Higher doses 250 or 500 mg qid are sometimes recommended for patients with very severe cdi, without supporting clinical evidence. Vancomycin injection, usp in the galaxy plastic container pl 2040 is a frozen, iso osmotic, sterile, nonpyrogenic premixed 100 ml, 150 ml, or 200 ml solution containing 500 mg, 750 mg, or 1 g vancomycin respectively as vancomycin hydrochloride. Vancomycin is used for the treatment and prevention of various bacterial. Full text pharmacistled implementation of a vancomycin. And significantly more patients had a vancomycin trough concentration within the target range when vancomycin was dosed by the nomogram for these patients as well. The results of this study revealed that implementation of a vancomycin nomogram into a cpoe system was associated with an increased percentage of patients with an. This document refers to the treatment of adult patients unless otherwise stated. Denetclaw et al11 evaluated divided vancomycin lds in 69 adult icu patients in a prospective, observational study table 1. Patients in the tdm group had vancomycin drug therapy monitored daily by a pharmacist and vancomycin dosages adjusted following a pharmacokinetic analysis of vancomycin serum concentrations. Concerning this recommendation, several nomograms have been constructed targeting this optimal trough level range in different populations of. The dosing interval of the nomogram was based on that published by matzke et al.
This study aimed to develop two vancomycin nomograms for the achievement of. Monographs for commonly administered intravenous medications. Published interpatient variability has been reported as 0. Monographs for commonly administered intravenous medications in home and community care 2 p a g e vancomycin administration1,2 a central line is preferred for administration of vancomycin, especially if concentration of mixed solution is 510 mgml usually in fluid restricted patients or if being administered for more than one week. Interval depends on patients renal function and targeted serum vancomycin concentration refer to tables on following page clinical pearls. Recent guidelines recommend a vancomycin trough predose level between 15 and 20 mgl in the treatment of invasive grampositive infections, but most initial.
This is the first time that a vancomycin nomogram has been constructed to achieve a trough concentration at the higher target range of 1520 mgl in an asian population. Denetclaw et al11 evaluated divided vancomycin lds in 69 adult icu patients in a prospective, observational study. Achievement of optimal vancomycin exposure is crucial to improve the management of patients with lifethreatening infections caused by susceptible grampositive bacteria and is of particular concern in patients with augmented renal clearance arc. To assess and validate the effectiveness of a newly constructed vancomycin dosing nomogram in achieving target trough serum concentrations of 1520 mgl. Sep 12, 2016 therapeutic monitoring of vancomycin in adults summary of consensus recommendations from the american society of healthsystem pharmacists, the infectious diseases society of america, and the society of infectious diseases pharmacists. Although numerous publications in the past several years have described the pharmacokinetics of vancomycin in various patient populations, disparity still exists regarding the most appropriate methods of monitoring, including therapeutic range, timing of peak determinations, and methods for determining doses. A novel vancomycin dosing nomogram was developed and validated at 2 canadian teaching hospitals. It is not appreciably absorbed orally and is eliminated primarily via the renal route, with 80%90% recovered unchanged in urine within 24 h after administration of a single dose.
Evaluation of a vancomycin dosing nomogram in achieving high. Based on our results, we found that implementation of a vancomycin nomogram in critically ill patients using actual body weight and the mdrd equation as an estimate of glomerular filtration rate to determine dosing frequency was more successful in achieving an initial vancomycin trough concentration 15. Prospective trial of a novel nomogram to achieve updated. Jan 01, 2006 prior to its release, vancomycin was used to treat an entity called postoperative micrococcal colitis. Regular spot plasma vancomycin concentrations should be monitored, generally starting within 24 hours of the first dose, and measured daily. Notable studies analyzing vancomycin dosing in obese patients have utilized protocols or nomograms that have based dosing on simplified mgkg calculations paired with estimated renal function for determining frequency. Vancomycin levels should be repeated until there are two consecutive levels within target range. Vancomycin is a glycopeptide antibiotic used to treat severe grampositive infections due to organisms that are resistant to other antibiotics such as. The patient should be at steady just before the fifth dose. This integrated nomogram is a tool that clinicians can use in selecting appropriate initial vancomycin regimens on the basis of age and serum creatinine, to achieve hightarget levels of 1520 mgl. Evaluation of the effectiveness of a vancomycin nomogram at predicting trough levels within a therapeutic range 714 mgl to avoid development of resistance, and ideally between 15 mgl and 20 mgl for complicated infections such as osteomyelitis.
Evaluation of the effectiveness of a vancomycin nomogram at predicting trough levels within a therapeutic range 714 mgl to avoid development of resistance, and ideally between 15 mgl and 20 mgl for complicated infections such as osteomyelitis, endocarditis, meningitis, bacteremia, and hospitalacquired. Targeting aucmic for vancomycin dosing the university of. Vancomycin nomogram goal trough 1520 mcgml 45 120 70 65 60 75 100 95 80 85 90 110 115 105 1500 q12 3417 1500 q12 3519 q8 2716 q8 2817 1500 q12 1250 q8 3118 1250 q8 3219 20 55 50 30 25 40 35 3316 75 l 1500 q8 3217 1500 q8 3318 1250 q8 2916 1250 q8 3016 70 l 1500 q8 3418 1250 q8 3016 3317 q24 2917 1500 q36 1250. Without further ado, we present the 8 mustknow em pharmacotherapy articles of 2016. Guidelines for monitoring of vancomycin serum concentrations in adult patients. Prospectively validated dosing nomograms for maximizing the. Treatment of mssa or other susceptible gram positive. Compared with aminoglycosides, the variability in the distribution volume of vancomycin is extreme. For obese patients total body weight 20% over ideal body weight, dosage requirement may best be estimated using an. Impact of vancomycin therapeutic drug monitoring on patient. After more than five decades of widespread clinical use, vancomycin may still have a major role in the treatment of multidrugresistant grampositive bacterial infections 18, 23, even though its clinical efficacy for the treatment of deepseated infections is often called into question because of it poor penetration into tissue and its relatively weak antibacterial activity 5, 33. Guidelines developed by uwhc department of pharmacy. Performance of a dividedload intravenous vancomycin.
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