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Critical Care

, 23:228 | Cite as

Attainment of therapeutic vancomycin level within the first 24 h

  • Patrick M. HonoreEmail author
  • David De Bels
  • Rachid Attou
  • Sebastien Redant
  • Andrea Gallerani
  • Kianoush Kashani
Open Access
Letter

Abbreviations

ARC

Augmented renal clearance

CI

Continuous infusion

ClCr

Creatinine clearance

CRRT

Continuous renal replacement therapy

ICU

Intensive care unit

RRT

Renal replacement therapy

Attaining adequate vancomycin levels among critically ill patients is an important issue. The early achievement of this target potentially avoids therapy failure, the emergence of multiresistant bacterial strains, and even possibly increased mortality [1, 2]. The primary goal of the study by Batista and colleagues [1], who used a creatinine clearance (ClCr)-based nomogram, was reaching the vancomycin target level with continuous infusion (CI) strategy. The authors reported no additional risk of nephrotoxicity and found CI to be superior to a loading dose of 35 mg/kg [1, 3]. Augmented renal clearance (ARC; creatinine clearance > 130 ml/min) was present in 40% of critically ill patients without acute kidney injury. The target vancomycin level of 20–30 mg/L at 24 h was achieved in 84% of patients [1]. Cristillini et al., in a cohort with a 21% incidence of ARC, used a loading dose of 35 mg/kg in 4 h and achieved the same target vancomycin (at 24 h) trough levels in 54% of the patients [4]. Vancomycin dosing during continuous renal replacement therapy (CRRT) is challenging and yet very important. Beumier et al. described that a 35-mg/kg loading dose during CRRT allows therapeutic vancomycin target level attainment in 63% of patients within 24 h [5]. Unfortunately, dosing nomogram proposed by Batista et al. has not been assessed in patients treated with RRT [1]. At this point, considering the lack of data, the loading vancomycin dose of 35 mg/kg remains the gold standard in CRRT patients. As there is a critical need to ascertain the most effective strategy to attain vancomycin therapeutic trough levels in patients treated with CRRT, future studies need to compare Batista et al. dosing protocol with the current standard of care.

Notes

Acknowledgements

None.

Authors’ contributions

PMH and KK designed the paper. All authors participated in drafting the manuscript. All authors have read and approved the final version.

Funding

None.

Ethics approval and consent to participate

Not applicable.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

References

  1. 1.
    Baptista JP, Roberts JA, Sousa E, Freitas R, Deveza N, Pimente LJ. decreasing the time to achieve therapeutic vancomycin concentrations in critically ill patients: developing and testing of a dosing nomogram. Crit Care. 2014;18:654.CrossRefGoogle Scholar
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    Claus BO, Hoste EA, Colpaert K, Robays H, Decruyenaere J, De Waele JJ. Augmented renal clearance is a common finding with worse clinical outcome in critically ill patients receiving antimicrobial therapy. J Crit Care. 2013;28:695–700.CrossRefGoogle Scholar
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    Roberts JATF, Udy AA, Vincent JL, Jacobs F, Lipman J. Vancomycin dosing in critically ill patients: robust methods for improved continuous-infusion regimens. Antimicrob Agents Chemother. 2011;55:2704–9.CrossRefGoogle Scholar
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    Cristallini S, Hites M, Kabtouri H, Roberts JA, Beumier M, Cotton F, et al. New regimen for continuous infusion of vancomycin in critically ill patients. Antimicrob Agents Chemother. 2016;60(8):4750–6.  https://doi.org/10.1128/AAC.00330-16.Print2016Aug.CrossRefPubMedPubMedCentralGoogle Scholar
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    Beumier M, Roberts JA, Kabtouri H, Hites M, Cotton F, Wolff F, et al. A new regimen for continuous infusion of vancomycin during continuous renal replacement therapy. J Antimicrob Chemother. 2013;68:2859–65.CrossRefGoogle Scholar

Copyright information

© The Author(s). 2019

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

Authors and Affiliations

  • Patrick M. Honore
    • 1
    Email author
  • David De Bels
    • 1
  • Rachid Attou
    • 1
  • Sebastien Redant
    • 1
  • Andrea Gallerani
    • 1
  • Kianoush Kashani
    • 2
  1. 1.ICU DepartmentCentre Hospitalier Universitaire Brugmann, Brugmann University HospitalBrusselsBelgium
  2. 2.Division of Nephrology and Hypertension, Division of Pulmonary and Critical Care MedicineMayo ClinicRochesterUSA

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