Vancomycin - Revision history

Aidan: /* Renal Failures */

2022-10-10T02:09:19Z

Renal Failures

← Older revision		Revision as of 02:09, 10 October 2022
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	*Risk factors: prolonged courses >21 days, higher troughs, concomitant nephrotoxic medication, older age, [[CKD]]/[[AKI]], [[liver disease]], [[peritonitis]], [[neutropenia]], and male sex		*Risk factors: prolonged courses >21 days, higher troughs, concomitant nephrotoxic medication, older age, [[CKD]]/[[AKI]], [[liver disease]], [[peritonitis]], [[neutropenia]], and male sex
	*Mechanism of injury: either AIN or ATN from oxidative stress in the proximal tubular cells		*Mechanism of injury: either AIN or ATN from oxidative stress in the proximal tubular cells
			**May be able to detect it early with serum Kim-1 elevation, or NGAL elevation (though less specific)

	===Red Person Syndrome===		===Red Person Syndrome===

2022-10-10T02:01:16Z

Adverse Reactions

← Older revision		Revision as of 02:01, 10 October 2022
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	===Renal Failures===		===Renal Failures===

			*Dose-dependent risk, with significant increase with trough over 15
	*Risk factors
			*Lower risk with AUC-based dosing, which promotes lower dosing, and with continuous infusion
	**Prolonged courses >21 days
			*Risk factors: prolonged courses >21 days, higher troughs, concomitant nephrotoxic medication, older age, [[CKD]]/[[AKI]], [[liver disease]], [[peritonitis]], [[neutropenia]], and male sex
	**Higher trough
		⚫	*Mechanism of injury: either AIN or ATN from oxidative stress in the proximal tubular cells
	**Concomitant nephrotoxic medication
	**Older age
	**[[CKD]]/[[AKI]]
	**[[Liver disease]]
	**[[Peritonitis]]
	**[[Neutropenia]]
	**Male sex
⚫	*Mechanism of injury: oxidative stress in the proximal tubular cells

	===Red Person Syndrome===		===Red Person Syndrome===

2022-03-31T20:25:11Z

Renal Dosing

← Older revision		Revision as of 20:25, 31 March 2022
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	** If next HD in 3 days, give 35 mg/kg		** If next HD in 3 days, give 35 mg/kg
	** Give at rate of 15 mg/min over the last 120 minutes of HD to coincide with the end of dialysis		** Give at rate of 15 mg/min over the last 120 minutes of HD to coincide with the end of dialysis
			**Alternatively:
			***< 70 kg: 1000mg IV x 1, then 500mg post-dialysis
			***70 –100kg: 1250mg IV x 1, then 750mg post-dialysis
			***>100 kg: 1500mg IV x 1, then 1000mg post-dialysis
	* CAPD: 7.5 mg/kg q48-96h		* CAPD: 7.5 mg/kg q48-96h
	* CRRT: 10-15 mg/kg q24-48h		* CRRT: 10-15 mg/kg q24-48h

2022-03-12T23:15:56Z

← Older revision		Revision as of 23:15, 12 March 2022
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	\|≥16		\|≥16
	\|-		\|-
	\|[[Staphylococcus ~~species~~]] other than ~~''S.~~ aureus''		\|[[Staphylococcus]] species other than [[Staphylococcus aureus]]
	\|≤4		\|≤4
	\|8-16		\|8-16
	\|≥32		\|≥32
	\|-		\|-
	\|[[Enterococcus ~~species~~]]		\|[[Enterococcus]]
	\|≤4		\|≤4
	\|8-16		\|8-16

2021-08-20T13:10:28Z

Dosing

2020-11-14T15:46:21Z

@@ Line 71: / Line 71: @@
 **15 mg/kg/dose with timing based on renal function (q12h if normal)
 **Titrate based on monitoring parameters (below)
-**Adjustments assume linear pharmacokinetics,so a doubling of the daily dose, for example, should double the trough or AUC:MIC
+**Adjustments assume linear pharmacokinetics, so a doubling of the daily dose, for example, should double the trough or AUC:MIC
 ===Obesity===

2020-09-28T10:13:41Z

Pharmacodynamics

← Older revision		Revision as of 10:13, 28 September 2020
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	**[[Weissella]]		**[[Weissella]]

	===Pharmacodynamics===		===Pharmacokinetics and Pharmacodynamics===

			*Bactericidal
⚫	*Efficacy predicted by AUC to MIC ~~ratio~~
			*Concentration-independent with post-antibiotic effect
		⚫	*Efficacy predicted by AUC<sub>24</sub>:MIC

	===Clinical Breakpoints===		===Clinical Breakpoints===
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	**Concomitant nephrotoxic medication		**Concomitant nephrotoxic medication
	**Older age		**Older age
	**CKD/AKI		**[[CKD]]/[[AKI]]
	**Liver disease		**[[Liver disease]]
	**Peritonitis		**[[Peritonitis]]
	**Neutropenia		**[[Neutropenia]]
	**Male sex		**Male sex
	*Mechanism of injury: oxidative stress in the proximal tubular cells		*Mechanism of injury: oxidative stress in the proximal tubular cells

2020-09-13T15:26:01Z

Clinical Breakpoints

← Older revision		Revision as of 15:26, 13 September 2020
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	\|≥16		\|≥16
	\|-		\|-
	\|[[Staphylococcus species]] other than ''aureus''		\|[[Staphylococcus species]] other than ''S. aureus''
	\|≤4		\|≤4
	\|8-16		\|8-16

2020-09-13T15:25:38Z

Breakpoints

← Older revision		Revision as of 15:25, 13 September 2020
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	*Efficacy predicted by AUC to MIC ratio		*Efficacy predicted by AUC to MIC ratio

	=== Breakpoints ===		===Clinical Breakpoints===
	{\| class="wikitable"		{\| class="wikitable"
	! rowspan="2" \|Species		! rowspan="2" \|Species
	! colspan="4" \|Breakpoints (μg/mL)		! colspan="3" \|Breakpoints (μg/mL)
	\|-		\|-
	!S		!S
	!SDD
	!I		!I
	!R		!R
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	\|[[Staphylococcus aureus]]		\|[[Staphylococcus aureus]]
	\|≤2		\|≤2
	\|—
	\|4-8		\|4-8
	\|≥16		\|≥16
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	\|[[Staphylococcus species]] other than ''aureus''		\|[[Staphylococcus species]] other than ''aureus''
	\|≤4		\|≤4
	\|—
	\|8-16		\|8-16
	\|≥32		\|≥32
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	\|[[Enterococcus species]]		\|[[Enterococcus species]]
	\|≤4		\|≤4
	\|—
	\|8-16		\|8-16
	\|≥32		\|≥32
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	\|[[Streptococcus pneumoniae]]		\|[[Streptococcus pneumoniae]]
	\|≤1		\|≤1
	\|—
	\|—		\|—
	\|—		\|—
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	\|[[β-hemolytic streptococci]]		\|[[β-hemolytic streptococci]]
	\|≤1		\|≤1
	\|—
	\|—		\|—
	\|—		\|—

2020-08-21T20:59:32Z

Indications