Early Vancomycin Concentrations and the Applications of a Pharmacokinetic Extrapolation Method to Recognize Sub-Therapeutic Outcomes
Abstract
:1. Background
1.1. Vancomycin Trough Monitoring
1.2. Importance of Trough Timing
2. Objective
3. Methods
3.1. Phase 1: Vancomycin Trough Review
3.2. Phase 2: Pharmacokinetic Trough Extrapolation
3.3. Phase 3: The Impact of Serum Concentration, Time, and CrCl
4. Results
5. Discussion
5.1. Verification of the Trough Timing Issue
5.2. Success of Education and Policy Interventions to Improve Trough Timing
5.3. Applications of a Pharmacokinetic Extrapolation Strategy
6. Limitations
7. Conclusions
Author Contributions
Conflicts of Interest
References
- Rybak, M.; Lomaestro, B.; Rotschafer, J.C.; Moellering, R., Jr.; Craig, W.; Billeter, M.; Dalovisio, J.R.; Levine, D.P. Therapeutic monitoring of vancomycin in adult patients: A consensus review of the American Society of Health-System Pharmacists, the Infectious Diseases Society of America, and the Society of Infectious Diseases Pharmacists. Am. J. Health Syst. Pharm. 2009, 66, 82–98. [Google Scholar] [CrossRef] [PubMed]
- Brown, D.L.; Lalla, C.D.; Masselink, A. AUC versus peak-trough dosing of vancomycin: Applying new pharmacokinetic paradigms to an old drug. Ther. Drug Monit. 2013, 35, 443–449. [Google Scholar] [CrossRef] [PubMed]
- Patel, N.; Pai, M.; Rodvold, K.A.; Lomaestro, B.; Drusano, G.L.; Lodise, T.P. Vancomycin: We can’t get there from here. Clin. Infect. Dis. 2011, 52, 969–974. [Google Scholar] [CrossRef] [PubMed]
- Morrison, A.P.; Melanson, S.E.F.; Carty, M.G.; Bates, D.W.; Szumita, P.M.; Tanasijevic, M.J. What proportion of vancomycin trough Levels are drawn too early? Am. J. Clin. Pathol. 2012, 137, 472–478. [Google Scholar] [CrossRef] [PubMed]
- Davis, S.L.; Scheetz, M.H.; Bosso, J.A.; Goff, D.A.; Rybak, M.J. Adherence to the 2009 consensus guidelines for vancomycin dosing and monitoring practices: A cross-sectional survey of U.S. hospitals. Pharmacotherapy 2013, 33, 1256–1263. [Google Scholar] [CrossRef] [PubMed]
- Koppula, S.; Ruben, S.; Bangash, F.; Szerlip, H.M. Pitfalls in dosing vancomycin. Am. J. Med. Sci. 2015, 349, 137–139. [Google Scholar] [CrossRef] [PubMed]
- Neely, M.N.; Young, G.; Jones, B.; Jelliffe, R.W.; Drusano, G.L.; Rodvold, K.A.; Lodise, T.P. Are vancomycin trough concentrations adequate for optimal dosing? Antimicrob. Agents Chemother. 2014, 58, 309–316. [Google Scholar] [CrossRef] [PubMed]
- Dib, J.G.; Al-Tawfiq, J.A.; Abdulmohsin, S.A.; Mohammed, K.; Jenden, P.D. Improvement in vancomycin utilization in adults in a Saudi Arabian medical center using the hospital infection control practices advisory committee guidelines and simple educational activity. J. Infect. Public Health 2009, 2, 141–146. [Google Scholar] [CrossRef] [PubMed]
- Ye, Z.K.; Li, C.; Zhai, S.D. Guidelines for therapeutic drug monitoring of vancomycin: A systematic review. PLoS ONE 2014, 9, e99044. [Google Scholar] [CrossRef] [PubMed]
- Cockcroft, D.W.; Gault, M.H. Prediction of creatinine clearance from serum creatinine. Nephron 1976, 16, 31–41. [Google Scholar] [CrossRef] [PubMed]
- Matzke, G.R.; McGory, R.W.; Halstenson, C.E.; Keane, W.F. Pharmacokinetics of vancomycin in patients with various degrees of renal function. Antimicrob. Agents Chemother. 1984, 25, 433–437. [Google Scholar] [CrossRef] [PubMed]
- Coleman, L.K.; Wilson, A.S. Impact of nursing education on the proportion of appropriately drawn vancomycin trough concentrations. J. Pharm Pract. 2015, 29, 472–474. [Google Scholar] [CrossRef] [PubMed]
- Melanson, S.E.F.; Mijailovic, A.S.; Wright, A.P.M.; Szumita, P.M.; Bates, D.W.; Tanasijevic, M.J. An intervention to improve the timing of vancomycin levels. Am. J. Clin. Pathol. 2013, 140, 801–806. [Google Scholar] [CrossRef] [PubMed]
- Traugott, K.A.; Maxwell, P.R.; Green, K.; Frei, C.; Lewis, J.S., II. Effects of therapeutic drug monitoring criteria in a computerized prescriber-order-entry system on the appropriateness of vancomycin level orders. Am. J. Health Syst. Pharm. 2011, 68, 347–352. [Google Scholar] [CrossRef] [PubMed]
- Cardile, A.P.; Tan, C.; Lustik, M.B.; Stratton, A.N.; Madar, C.S.; Elegino, J.; Hsue, G. Optimization of time to initial vancomycin target trough improves clinical outcomes. SpringerPlus 2015, 4, 364. [Google Scholar] [CrossRef] [PubMed]
- Panday, P.N.; Sturkenboom, M. Continuous Infusion of Vancomycin Less Effective and Safe than Intermittent Infusion, Based on Pharmacodynamic and Pharmacokinetic Principles. Clin. Infect. Dis. 2009, 49, 1964–1965. [Google Scholar] [CrossRef] [PubMed]
Trough Concentrations Suitable for Analysis | 143 |
---|---|
Trough Measured within 0.5 h of Next Dose | 81 (57%) |
Trough Measured >0.5 h and <2 h Prior to Next Dose | 34 (24%) |
Trough Measured ≥2 h Prior to Next Dose | 28 (19%) |
Infection Type | Trough Range (mg/L) | Number of Troughs (48) | Number of Sub-Therapeutic True Concentrations b,c | Percentage (%) |
---|---|---|---|---|
Mild/Moderate | 10–15 | 21 | 6 | 28.5 |
Complicated a | 15–20 | 27 | 6 | 22.2 |
Total | 10–20 | 48 | 12 | 25 |
CrCl Group (ml/min) | Number of Troughs (n) | CrCla (ml/min) | Measured Trough (mg/L) | Estimated True Troughb (mg/L) | Trough Differencec (mg/L) | |
---|---|---|---|---|---|---|
Trough Measured ≥2 h Prior to Next Dose | ≥60 | 11 | 88.3 (64–126) | 17.5 (13.6–22.7) | 12.9 (7.5–19.1) | 4.6 (2.0–6.6) |
<60 | 12 | 37.4 (16–59) | 16.3 (10.3–29.4) | 14.2 (9.2–25.2) | 2.1 (0.6–6.4) | |
Trough Measured >0.5 and <2 h Prior to Next Dose | ≥60 | 15 | 87.7 (63–123) | 16.4 (10.2–26) | 15.2 (9.3–22.8) | 1.2 (0.5–3.2) |
<60 | 10 | 43.1 (27–59) | 16.0 (10.3–23.6) | 15.4 (9.8–23.1) | 0.6 (0.4–0.9) | |
Total | 48 | 65.5 (16–126) | 16.6 (10.2–29.4) | 14.5 (7.5–25.2) | 2.1 (0.4–6.6) |
© 2016 by the authors; licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/).
Share and Cite
Santalo, O.; Baig, U.; Poulakos, M.; Brown, D. Early Vancomycin Concentrations and the Applications of a Pharmacokinetic Extrapolation Method to Recognize Sub-Therapeutic Outcomes. Pharmacy 2016, 4, 37. https://doi.org/10.3390/pharmacy4040037
Santalo O, Baig U, Poulakos M, Brown D. Early Vancomycin Concentrations and the Applications of a Pharmacokinetic Extrapolation Method to Recognize Sub-Therapeutic Outcomes. Pharmacy. 2016; 4(4):37. https://doi.org/10.3390/pharmacy4040037
Chicago/Turabian StyleSantalo, Oscar, Umima Baig, Mara Poulakos, and Daniel Brown. 2016. "Early Vancomycin Concentrations and the Applications of a Pharmacokinetic Extrapolation Method to Recognize Sub-Therapeutic Outcomes" Pharmacy 4, no. 4: 37. https://doi.org/10.3390/pharmacy4040037