Vancomycin: Difference between revisions
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+ | ==Background== |
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+ | *A [[:Category:Glycopeptides|glycopeptide]] antibiotic |
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+ | ===Mechanism of action=== |
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+ | *Inhibits cross-linking of peptidoglycans in the cell wall |
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+ | ===Pharmacodynamics=== |
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+ | *Efficacy predicted by AUC to MIC ratio |
==Indications== |
==Indications== |
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*Common dose |
*Common dose |
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| + | **Loading dose of 20 mg/kg given once for serious infections |
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+ | **15 mg/kg/dose with timing based on renal function (q12h if normal) |
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| + | **Titrate based on monitoring parameters (below) |
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| − | *Target trough |
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| + | **Adjustments assume linear pharmacokinetics,so a doubling of the daily dose, for example, should double the trough or AUC:MIC |
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===Obesity=== |
===Obesity=== |
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*Dosing should use actual body weight, with a maximum loading dose of 3 g |
*Dosing should use actual body weight, with a maximum loading dose of 3 g |
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| + | === Monitoring === |
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| + | * Based on PK/PD modelling, the '''trough level''' was previously used to dose vancomycin |
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==Adverse Reactions== |
==Adverse Reactions== |
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Revision as of 10:07, 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
- Loading dose of 20 mg/kg given once for serious infections
- 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
Obesity
- Dosing should use actual body weight, with a maximum loading dose of 3 g
Monitoring
- Based on PK/PD modelling, the trough level was previously used to dose vancomycin
- Serum trough drawn within hour before fourth dose
- 10-15 for low-risk infections
- 15-20 for high-risk Staphylococcus aureus infections such as osteomyelitis, meningitis, and bacteremia
- Current guidelines recommend AUC:MIC monitoring using Bayesian calculators1
- Target AUC/MICBMD ratio of 400 to 600 for serious Staphylococcus aureus infections
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.
