Intensive Care Medicine

, Volume 33, Issue 2, pp 279–285

Pharmacokinetic/pharmacodynamic analysis of vancomycin in ICU patients

  • Maria del Mar Fernández de Gatta Garcia
  • Natalia Revilla
  • Maria Victoria Calvo
  • Alfonso Domínguez-Gil
  • Amparo Sánchez Navarro
Original

DOI: 10.1007/s00134-006-0470-5

Cite this article as:
del Mar Fernández de Gatta Garcia, M., Revilla, N., Calvo, M.V. et al. Intensive Care Med (2007) 33: 279. doi:10.1007/s00134-006-0470-5

Abstract

Aims

To identify the variables affecting vancomycin pharmacokinetics in medical ICU patients and to evaluate the potential efficacy of dosage schedules by PK/PD analysis.

Design

A retrospective pharmacokinetic analysis of serum levels obtained in routine vancomycin monitoring was performed.

Setting

A 12-bed general ICU of a university teaching hospital.

Patients

Forty-six vancomycin-treated ICU patients fitting the following criteria: over 18 years old; more than three concentration data per patient; absence of renal replacement support, cardiac surgery and neoplastic disorders.

Interventions

Clinical information was collected from the patients' medical records. Details of vancomycin therapy, dosage and blood sampling times were obtained from pharmacokinetic reports. Population analysis were made by the standard two-stage approach.

Measurements and main results

Vancomycin clearance and distribution volume were estimated individually assuming a one-compartment pharmacokinetic model. PK/PD analysis was performed by Monte Carlo simulation. In the ICU patients, higher Vd (nearly twice the quoted value of 0.72 l/kg) and different vancomycin clearance–creatinine clearance relationship were found. Renal function, the APACHE score, age and serum albumin accounted for more than 65% of drug clearance variability. Vancomycin standard dosages led to a 33% risk of not achieving the recommended AUC24h/MIC breakpoint for Staphylococcus aureus.

Conclusions

The population kinetics and PK/PD analyses based on Monte Carlo simulation procedures offer an excellent tool for selecting the therapeutic option with the highest probability of clinical success in ICU patients.

Keywords

Vancomycin ICU patients Population kinetics Dosage optimisation PK/PD analysis Monte Carlo simulation 

Supplementary material

134_2006_470_MOESM1_ESM.doc (26 kb)
Electronic Supplementary Material (DOC 26K)

Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  • Maria del Mar Fernández de Gatta Garcia
    • 1
  • Natalia Revilla
    • 2
  • Maria Victoria Calvo
    • 1
    • 2
  • Alfonso Domínguez-Gil
    • 1
    • 2
  • Amparo Sánchez Navarro
    • 1
  1. 1.Pharmacy DepartmentUniversity of SalamancaSalamancaSpain
  2. 2.University Hospital of SalamancaSalamancaSpain