Volume 17 Supplement 3

Seventh International Symposium on Intensive Care and Emergency Medicine for Latin America

Open Access

Vancomycin dose adjustment in severe burn patients based on trough level for drug effectiveness against pathogens at 1 mg/l minimum inhibitory concentration

  • JM SilvaJr1,
  • AM Oliveira1,
  • EV Campos1,
  • DS Gomez1,
  • MC Ferreira1,
  • CS Giraud2,
  • CV SilvaJr2 and
  • SRCJ Santos2
Critical Care201317(Suppl 3):P29

https://doi.org/10.1186/cc12645

Published: 19 June 2013

Introduction

Vancomycin is usually prescribed to severe burn patients with sepsis from the intensive care burn unit (ICBU) for control of hospital infection. The objective of this study was to evaluate the contribution of dose regimen adjusted in burn patients with renal function preserved based on drug plasma concentration at the trough and pharmacokinetic-pharmacodynamic (PK/PD) correlation.

Methods

Sixty severe burn patients with documented Gram-positive nosocomial infection from the ICBU were enrolled in a prospective cohort study, and the period of inclusion was 2 years; the protocol was approved by the hospital's ethical committee. Patients of both genders (43 male/17 female) with preserved renal function were investigated (176 sets). The vancomycin dose regimen was initially 2 g daily for the control of infection in burn patients with sepsis. Pharmacotherapeutic follow-up was performed by a serial blood sample collection (2 ml each) for drug plasma measurements [1]. Drug effectiveness was based on the parameter AUCss0-24/MIC >400 [2]; AUCss0-24 was the area under the curve (plasma concentration vs. time) integrated up to 24 hours, and the minimum inhibitory concentration (MIC) from in vitro antimicrobial susceptibility testing performed in the hospital [2]. Dose adjustment was required and the daily dose was increased to reach trough levels >10 μg/ml and AUC/MIC >400.

Results

Characteristics of patients investigated were (mean ± SD): 38.9 ± 14.1 years; 70.0 ± 10.6 kg, 28.0 ± 19.0% total burn surface area. Thermal injury occurred in 51/60 patients, and inhalation injury occurred in 54.9% of them, versus electrical injury reported in 9/60 patients; renal function was monitored by serum creatinine (0.72 ± 0.29 mg/dl) and creatinine clearance (153.7 ± 70.4 ml/minute). Significant increase was chosen by comparison of the initial dose against adjusted dose according to trough levels >10 g/ml and also AUC/MIC >400 (Table 1).
Table 1

Daily dose medians, trough and PK/PD data

Parameter

Initial dose

Adjusted dose

P value

Daily dose (mg/kg/day)

28.6

42.9

0.01

Trough levels (μg/ml)

7.1(3.6 to 13.3)

16.0 (12.0 to 23.3)

<0.001

AUC/MIC (MIC: 1 mg/l)

436 (248 to 659)

648 (467 to 942)

0.02

Data presented as median (25 to 75% percentile).

Conclusion

The initial dose recommended for vancomycin must be increased according to trough levels and also AUC/MIC to achieve the PK/PD target in burn patients with preserved renal function.

Declarations

Acknowledgements

Foundation for Research State of Sao Paulo/SP, Brazil (FAPESP).

Authors’ Affiliations

(1)
Burn Unit/Plastic Surgery Division of Clinics Hospital, Medical School, University of Sao Paulo
(2)
School of Pharmaceutical Sciences, University of Sao Paulo

References

  1. Lopéz KJV, Bertoluci DF, Vicente KM, Dell'Aquilla AM, Santos SRCJ: Simultaneous determination of cefepime, vancomycin and imipenem in human plasma of burn patients by high performance liquid chromatography. J Chromatogr B 2007, 860: 241-245. 10.1016/j.jchromb.2007.10.041View ArticleGoogle Scholar
  2. Revilla N, Marín-Suárez A, Pérez MP, González FM, Gatta MMF: Vancomycin dosing assessment on intensive care unit patients based on a population pharmacokinetic/pharmacodynamic simulation. Br J Clin Pharmacol 2010, 70: 201-212. 10.1111/j.1365-2125.2010.03679.xPubMed CentralView ArticlePubMedGoogle Scholar

Copyright

© Silva et al; licensee BioMed Central Ltd. 2013

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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