Vancomycin: Difference between revisions
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* Target trough |
* Target trough |
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** 10-15 for low-risk infections |
** 10-15 for low-risk infections |
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** 15-20 for high-risk infections such as osteomyelitis, meningitis, and bacteremia |
** 15-20 for high-risk [[Staphylococcus aureus]] infections such as osteomyelitis, meningitis, and bacteremia |
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* Current guidelines recommend more involved PK/PD monitoring[[CiteRef::rybak2020th]] |
* Current guidelines recommend more involved PK/PD monitoring[[CiteRef::rybak2020th]] |
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** Target AUC/MIC<sub>BMD</sub> ratio of 400 to 600 |
** Target AUC/MIC<sub>BMD</sub> ratio of 400 to 600 |
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Revision as of 11:56, 13 June 2020
Indications
- Suspected or confirmed MRSA
Dosing
- Common dose
- 15mg/kg/dose with timing based on renal function (q12h if normal)
- Titrate based on serum trough drawn within hour before fourth dose
- Target trough
- 10-15 for low-risk infections
- 15-20 for high-risk Staphylococcus aureus infections such as osteomyelitis, meningitis, and bacteremia
- Current guidelines recommend more involved PK/PD monitoring1
- Target AUC/MICBMD ratio of 400 to 600
Obesity
- Dosing should use actual body weight, with a maximum loading dose of 3 g
Adverse Reactions
- Primarily include renal failure and red person syndrome
Renal Failures
- Risk factors
- Prolonged courses >21 days
- Higher trough
- 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
- Rash, pruritis, and hypotension, with onset of vancomycin, resolves on stopping
- Very high incidence previously
- Histamine-mediated
- Can decrease dose or prolong infusion, prophylactic antihistamines
References
- ^ Michael J Rybak, Jennifer Le, Thomas P Lodise, Donald P Levine, John S Bradley, Catherine Liu, Bruce A Mueller, Manjunath P Pai, Annie Wong-Beringer, John C Rotschafer, Keith A Rodvold, Holly D Maples, Benjamin M Lomaestro. Therapeutic monitoring of vancomycin for serious methicillin-resistant Staphylococcus aureus infections: A revised consensus guideline and review by the American Society of Health-System Pharmacists, the Infectious Diseases Society of America, the Pediatric Infectious Diseases Society, and the Society of Infectious Diseases Pharmacists. American Journal of Health-System Pharmacy. 2020. doi:10.1093/ajhp/zxaa036.
