Dose Optimization of Vancomycin for Critically Ill Patients Undergoing CVVH: A Prospective Population PK/PD Analysis

The optimal dose of vancomycin in critically ill patients receiving continuous venovenous hemofiltration (CVVH) remains unclear. The objective of this study was to identify factors that significantly affect pharmacokinetic profiles and to further investigate the optimal dosage regimens for criticall...

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Autores principales:	Chuhui Wang, Chao Zhang, Xiaoxiao Li, Sixuan Zhao, Na He, Suodi Zhai, Qinggang Ge
Formato:	article
Lenguaje:	EN
Publicado:	MDPI AG 2021
Materias:	vancomycin CVVH dose optimization population pharmacokinetics Therapeutics. Pharmacology RM1-950
Acceso en línea:	https://doaj.org/article/19ecfca24f6c4958a9ae0b8ab820bb3a
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spelling	oai:doaj.org-article:19ecfca24f6c4958a9ae0b8ab820bb3a2021-11-25T16:24:36ZDose Optimization of Vancomycin for Critically Ill Patients Undergoing CVVH: A Prospective Population PK/PD Analysis10.3390/antibiotics101113922079-6382https://doaj.org/article/19ecfca24f6c4958a9ae0b8ab820bb3a2021-11-01T00:00:00Zhttps://www.mdpi.com/2079-6382/10/11/1392https://doaj.org/toc/2079-6382The optimal dose of vancomycin in critically ill patients receiving continuous venovenous hemofiltration (CVVH) remains unclear. The objective of this study was to identify factors that significantly affect pharmacokinetic profiles and to further investigate the optimal dosage regimens for critically ill patients undergoing CVVH based on population pharmacokinetics and pharmacodynamic analysis. A prospective population pharmacokinetic analysis was performed at the surgical intensive care unit in a level A tertiary hospital. We included 11 critically ill patients undergoing CVVH and receiving intravenous vancomycin. Serial blood samples were collected from each patient, with a total of 131 vancomycin concentrations analyzed. Nonlinear mixed effects models were developed using NONMEM software. Monte Carlo Simulation was used to optimize vancomycin dosage regimens. A two-compartment model with first-order elimination was sufficient to characterize vancomycin pharmacokinetics for CVVH patients. The population typical vancomycin clearance (CL) was 1.15 L/h and the central volume of distribution was 16.9 L. CL was significantly correlated with ultrafiltration rate (UFR) and albumin level. For patients with normal albumin and UFR between 20 and 35 mL/kg/h, the recommended dosage regimen was 10 mg/kg qd. When UFR was between 35 and 40 mL/kg/h, the recommended dosage regimen was 5 mg/kg q8h. For patients with hypoalbuminemia and UFR between 20 and 25 mL/kg/h, the recommended dosage regimen was 5 mg/kg q8h. When UFR was between 25 and 40 mL/kg/h, the recommended dosage regimen was 10 mg/kg q12h. We recommend clinicians choosing the optimal initial vancomycin dosage regimens for critically ill patients undergoing CVVH based on these two covariates.Chuhui WangChao ZhangXiaoxiao LiSixuan ZhaoNa HeSuodi ZhaiQinggang GeMDPI AGarticlevancomycinCVVHdose optimizationpopulation pharmacokineticsTherapeutics. PharmacologyRM1-950ENAntibiotics, Vol 10, Iss 1392, p 1392 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	vancomycin CVVH dose optimization population pharmacokinetics Therapeutics. Pharmacology RM1-950
spellingShingle	vancomycin CVVH dose optimization population pharmacokinetics Therapeutics. Pharmacology RM1-950 Chuhui Wang Chao Zhang Xiaoxiao Li Sixuan Zhao Na He Suodi Zhai Qinggang Ge Dose Optimization of Vancomycin for Critically Ill Patients Undergoing CVVH: A Prospective Population PK/PD Analysis
description	The optimal dose of vancomycin in critically ill patients receiving continuous venovenous hemofiltration (CVVH) remains unclear. The objective of this study was to identify factors that significantly affect pharmacokinetic profiles and to further investigate the optimal dosage regimens for critically ill patients undergoing CVVH based on population pharmacokinetics and pharmacodynamic analysis. A prospective population pharmacokinetic analysis was performed at the surgical intensive care unit in a level A tertiary hospital. We included 11 critically ill patients undergoing CVVH and receiving intravenous vancomycin. Serial blood samples were collected from each patient, with a total of 131 vancomycin concentrations analyzed. Nonlinear mixed effects models were developed using NONMEM software. Monte Carlo Simulation was used to optimize vancomycin dosage regimens. A two-compartment model with first-order elimination was sufficient to characterize vancomycin pharmacokinetics for CVVH patients. The population typical vancomycin clearance (CL) was 1.15 L/h and the central volume of distribution was 16.9 L. CL was significantly correlated with ultrafiltration rate (UFR) and albumin level. For patients with normal albumin and UFR between 20 and 35 mL/kg/h, the recommended dosage regimen was 10 mg/kg qd. When UFR was between 35 and 40 mL/kg/h, the recommended dosage regimen was 5 mg/kg q8h. For patients with hypoalbuminemia and UFR between 20 and 25 mL/kg/h, the recommended dosage regimen was 5 mg/kg q8h. When UFR was between 25 and 40 mL/kg/h, the recommended dosage regimen was 10 mg/kg q12h. We recommend clinicians choosing the optimal initial vancomycin dosage regimens for critically ill patients undergoing CVVH based on these two covariates.
format	article
author	Chuhui Wang Chao Zhang Xiaoxiao Li Sixuan Zhao Na He Suodi Zhai Qinggang Ge
author_facet	Chuhui Wang Chao Zhang Xiaoxiao Li Sixuan Zhao Na He Suodi Zhai Qinggang Ge
author_sort	Chuhui Wang
title	Dose Optimization of Vancomycin for Critically Ill Patients Undergoing CVVH: A Prospective Population PK/PD Analysis
title_short	Dose Optimization of Vancomycin for Critically Ill Patients Undergoing CVVH: A Prospective Population PK/PD Analysis
title_full	Dose Optimization of Vancomycin for Critically Ill Patients Undergoing CVVH: A Prospective Population PK/PD Analysis
title_fullStr	Dose Optimization of Vancomycin for Critically Ill Patients Undergoing CVVH: A Prospective Population PK/PD Analysis
title_full_unstemmed	Dose Optimization of Vancomycin for Critically Ill Patients Undergoing CVVH: A Prospective Population PK/PD Analysis
title_sort	dose optimization of vancomycin for critically ill patients undergoing cvvh: a prospective population pk/pd analysis
publisher	MDPI AG
publishDate	2021
url	https://doaj.org/article/19ecfca24f6c4958a9ae0b8ab820bb3a
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Dose Optimization of Vancomycin for Critically Ill Patients Undergoing CVVH: A Prospective Population PK/PD Analysis

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