Skip to main content
  • Poster presentation
  • Open access
  • Published:

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

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

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.

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.2007.10.041

    Article  Google 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.x

    Article  PubMed Central  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

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

Author information

Authors and Affiliations

Authors

Rights and permissions

This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Cite this article

Silva, J., Oliveira, A., Campos, E. et al. Vancomycin dose adjustment in severe burn patients based on trough level for drug effectiveness against pathogens at 1 mg/l minimum inhibitory concentration. Crit Care 17 (Suppl 3), P29 (2013). https://doi.org/10.1186/cc12645

Download citation

  • Published:

  • DOI: https://doi.org/10.1186/cc12645

Keywords