Abstract
The standard dosage of vancomycin in haemodialysis patients is usually 1 gram, once a week. The aim of our study was to investigate vancomycin clearance by two highly permeable membranes and to determine whether dosage adjustment is necessary in regular haemodialysis settings when using these type of dialyzers.
12 patients on regular haemodialysis and treated with vancomycin either prophylactically or therapeutically were prospectively randomised to either dialysis with a polyacrylonitril parallel membrane (AN‐69®) or a cellulose‐acetate hollow fiber membrane. After administering vancomycin to the patient vancomycin plasma levels were measured at different intervals. The vancomycin clearance by the dialyzer was calculated from blood samples taken 1 hour after commencing dialysis. The data were used for pharmacokinetic computer simulation in order to develop a vancomycin dosage regimen for patients on regular haemodialysis with highly permeable membranes. The mean vancomycin dialysis clearance was 46 ± 5 ml/min and did not differ between the two artificial kidneys. Dialysis clearance of vancomycin was independent of blood flow rate.
Together with the dialyzer data a pharmacokinetic profile of each patient was calculated from the plasma samples. The average non‐renal clearance was 3.3 ml/min/1.73 m2 while renal vancomycin clearance, as a fraction of creatinine clearance, was found to be 0.83 ± 0.20. The computer calculations predicted that, irrespective of residual renal function, in most patients on regular haemodialysis and treated with these type of artificial kidneys, therapeutic and non‐toxic vancomycin levels could be obtained by giving 1000 mg of vancomycin intravenously as a loading dosage and 500 mg during every subsequent dialysis.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Freeman CD, Quintiliani R, Nightingale CH. Vancomycin therapeutic drug monitoring: is it necessary? Ann Pharmacother 1993;27:594–8.
Matzke GR, Zhanel GG, Guay DRP. Clinical Pharmacokinetics of vancomycin. Clin Pharmacokin 1986;11:257–82.
Bastani B, Spyker DA, Minocha A, Cummings R, Westervelt FB. In vivo comparison of three different hemodialysis mem-branes for vancomycin clearance: Cuprophan, cellulose acetate and polyacrylonitrile. Dial Transplant 1988;17:527–43.
Torras J, Cao C, Rivas MC, Cano M, Fernandez E, Montoliu J, et al. Pharmacokinetics of vancomycin in patients undergo-ing hemodialysis with polyacrylonitrile. Clin Nephrol 1991;36:35–41.
Lanese DM, Alfrey PS Molitoris BA. Markedly increased clear-ance of vancomycin during haemodialysis using polysulfon dialyzers. Kidney Int 1989;35:1409–12.
Cunha BA, Quintiliani R, Deglin JM, Irard MW, Nightingale CH. Pharmacokinetics of vancomycin in anuria. Rev Infect Dis 1981;3:S269–S72.
Tan CC, Lee HS, Ti Ty, Lee EJC. Pharmacokinetics of intrave-nous vancomycin in patients with end-stage renal failure. Ther Drug Monit 1990;12:29–34.
De Bock V, Verbeelen D, Maes V, Sennesael J. Pharmacokinetics of vancomycin in patients undergoing haemodialysis and haemofiltration. Nephrol Dial Transplant 1989;4:635–9.
White LO, Edwards R, Holt HA, Lovering AM, Finch RG, Reeves DS. The in vitro degradation at 37°C in serum, CAPD fluid and phosphate buffered saline. J Antimicrob Chemother 1988;22:739–45.
Lee CC, Marbury TC. Drug therapy in patiënts undergoing haemodialysis. Clin Pharmacokin 1984;9:42–66.
Van Stone JC. Haemodialysis apparatus. In: Daugirdas JT and Ing TS, eds. Handbook of dialysis. Boston: Little Brown and Company 1988; chapter 3:21–39.
Hoenick NA, Kerr DNS. Dialysers. In: Drukker W, Parsons FM and Maher JF, eds. Replacement of renal function by dialysis. Boston: Martinus Nijhoff Publishers, 1986:122–3.
Hurst AH, Yoshinaga MA, Mitani GH, Foo KA, Jelliffe RW, Harrison EC. Application of a Bayesian method to monitor and adjust vancomycin regimens. Antimicrob Agents Chemother 1990;34:1165–71.
Böhler J, Reetze-Bonorden P, Keller E, Kramer A, Schollmeyer PJ. Rebound of plasma vancomycin after haemodialysis with highly permeable membranes. Eur J Clin Pharmacol 1992;42:635–40.
Newfield P, Roizen MF. Hazards of Rapid Administration of vancomycin. Ann Intern Med 1979;91:581.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Zoer, J., Schrander-van der Meer, A. & van Dorp, W. Dosage recommendation of vancomycin during haemodialysis with highly permeable membranes.. Pharm World Sci 19, 191–196 (1997). https://doi.org/10.1023/A:1008600104232
Issue Date:
DOI: https://doi.org/10.1023/A:1008600104232