Vancomycin: Difference between revisions

Revision as of 10:03, 16 July 2020

Background

A glycopeptide antibiotic

Mechanism of action

Inhibits cross-linking of peptidoglycans in the cell wall

Pharmacodynamics

Efficacy predicted by AUC to MIC ratio

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/MIC_BMD 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.

@@ Line 1: / Line 1: @@
-== Indications ==
+== Background ==
+* A [[:Category:Glycopeptides|glycopeptide]] antibiotic
-* Suspected or confirmed MRSA
-== Dosing ==
+=== Mechanism of action ===
+* Inhibits cross-linking of peptidoglycans in the cell wall
-* 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 monitoring[[CiteRef::rybak2020th]]
-** Target AUC/MIC<sub>BMD</sub> ratio of 400 to 600
-=== Obesity ===
+=== Pharmacodynamics ===
-* Dosing should use actual body weight, with a maximum loading dose of 3 g
+* Efficacy predicted by AUC to MIC ratio
-== Adverse Reactions ==
-* Primarily include [[Adverse drug reaction::renal failure]] and [[Adverse drug reaction::red person syndrome]]
+==Indications==
-=== Renal Failures ===
-* Risk factors
-** Prolonged courses &gt;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
+*Suspected or confirmed MRSA
-=== Red Person Syndrome ===
-* Rash, pruritis, and hypotension, with onset of vancomycin, resolves on stopping
+==Dosing==
-* Very high incidence previously
-* Histamine-mediated
+*Common dose
-* Can decrease dose or prolong infusion, prophylactic antihistamines
+**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 monitoring[[CiteRef::rybak2020th]]
+**Target AUC/MIC<sub>BMD</sub> ratio of 400 to 600
+===Obesity===
+*Dosing should use actual body weight, with a maximum loading dose of 3 g
+==Adverse Reactions==
+*Primarily include [[Adverse drug reaction::renal failure]] and [[Adverse drug reaction::red person syndrome]]
+===Renal Failures===
+*Risk factors
+**Prolonged courses &gt;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
 [[Category:Glycopeptides]]