Vancomycin dose adjustment in severe burn patients based on trough level for drug effectiveness against pathogens at 1 mg/l minimum inhibitory concentration
© Silva et al; licensee BioMed Central Ltd. 2013
Published: 19 June 2013
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.
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 . Drug effectiveness was based on the parameter AUCss0-24/MIC >400 ; 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 . Dose adjustment was required and the daily dose was increased to reach trough levels >10 μg/ml and AUC/MIC >400.
Daily dose medians, trough and PK/PD data
Daily dose (mg/kg/day)
Trough levels (μg/ml)
7.1(3.6 to 13.3)
16.0 (12.0 to 23.3)
AUC/MIC (MIC: 1 mg/l)
436 (248 to 659)
648 (467 to 942)
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.
Foundation for Research State of Sao Paulo/SP, Brazil (FAPESP).
- 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
- 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
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