Publication
Decreasing the time to achieve therapeutic vancomycin concentrations in critically ill patients: developing and testing of a dosing nomogram
| dc.contributor.author | Baptista, JP | |
| dc.contributor.author | Roberts, JA | |
| dc.contributor.author | Sousa, E | |
| dc.contributor.author | Freitas, R | |
| dc.contributor.author | Deveza, N | |
| dc.contributor.author | Pimentel, J | |
| dc.date.accessioned | 2016-12-12T16:03:18Z | |
| dc.date.available | 2016-12-12T16:03:18Z | |
| dc.date.issued | 2014-12-05 | |
| dc.description.abstract | INTRODUCTION: Achievement of optimal vancomycin exposure is crucial to improve the management of patients with life-threatening infections caused by susceptible Gram-positive bacteria and is of particular concern in patients with augmented renal clearance (ARC). The aim of this study was to develop a dosing nomogram for the administration of vancomycin by continuous infusion for the first 24 hours of therapy based on the measured urinary creatinine clearance (8 h CLCR). METHODS: This single-center study included all critically ill patients treated with vancomycin over a 13-month period (group 1), in which we retrospectively assessed the correlation between vancomycin clearance and 8 h CLCR. This data was used to develop a formula for optimised drug dosing. The efficiency of this formula was prospectively evaluated in a second cohort of 25 consecutive critically ill patients (group 2). Vancomycin serum concentrations between 20 to 30 mg/L were considered adequate. ARC was defined as 8 h CLCR more than 130 ml/min/1.73 m(2). RESULTS: The incidence of ARC was 36% (n = 29/79) and 40% (10/25) in group 1 (n = 79) and 2 (n = 25), respectively. The mean serum vancomycin concentration on day 1 was 21.5 (6.4) and 24.5 (5.2) mg/L, for both groups respectively. On the treatment day, vancomycin plasma clearance was 5.12 (1.9) L/h in group 1 and correlated significantly with the 8 h CLCR (r(2) = 0.66; P < 0.001). The achievement of adequate vancomycin serum concentrations in group 2 was 84% (n = 21/25) versus 51% (n = 40/79) - P < 0.005. CONCLUSIONS: This new vancomycin nomogram enabled the achievement of adequate serum concentrations in 84% of the patients on the first day of treatment. | pt_PT |
| dc.identifier.citation | Crit Care. 2014 Dec 5;18(6):654. | pt_PT |
| dc.identifier.doi | 10.1186/s13054-014-0654-2 | pt_PT |
| dc.identifier.uri | http://hdl.handle.net/10400.4/1996 | |
| dc.language.iso | eng | pt_PT |
| dc.peerreviewed | yes | pt_PT |
| dc.subject | Vancomicina | pt_PT |
| dc.subject | Antibacterianos | pt_PT |
| dc.subject | Cuidados Intensivos | pt_PT |
| dc.subject | Nomograms | pt_PT |
| dc.title | Decreasing the time to achieve therapeutic vancomycin concentrations in critically ill patients: developing and testing of a dosing nomogram | pt_PT |
| dc.type | journal article | |
| dspace.entity.type | Publication | |
| oaire.citation.issue | 6 | pt_PT |
| oaire.citation.startPage | 654 | pt_PT |
| oaire.citation.volume | 18 | pt_PT |
| rcaap.rights | openAccess | pt_PT |
| rcaap.type | article | pt_PT |