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Vancomycin Pharmacokinetic Parameters in Patients with Hemorrhagic Stroke

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Abstract

Background

Infections are a common medical complication in hemorrhagic stroke patients, with vancomycin commonly used as empiric therapy. The purpose of this study was to evaluate the pharmacokinetic parameters of vancomycin in hemorrhagic stroke patients.

Methods

This was a retrospective study of adult patients with aneurysmal subarachnoid hemorrhage (aSAH) or intracerebral hemorrhage (ICH) admitted between May 2010 and February 2015 who received vancomycin. Predicted pharmacokinetic parameters based on population data were compared with calculated pharmacokinetic parameters based on serum trough concentrations.

Results

Eighty aSAH patients and 66 ICH patients met inclusion criteria. In the aSAH group, the mean dosing regimen was 17.6 ± 4 mg/kg every 12 (8–12) h. The mean measured trough concentration was lower than the predicted trough concentration (9.9 ± 4.1 vs. 19 ± 8.7 μg/mL; p < 0.001). The mean calculated elimination rate constant was higher than the predicted value (0.135 ± 0.04 vs. 0.092 ± 0.03 h−1; p < 0.001), and the mean calculated half-life was lower than predicted (5.7 ± 1.8 vs. 8.3 ± 2.9 h; p < 0.001). In the ICH group, the mean dosing regimen was 15.9 ± 4.3 mg/kg every 12 (8–12) h. Similarly, the mean measured trough concentration was lower than the predicted trough concentration (10.7 ± 4.6 vs. 17.5 ± 8.5 μg/mL; p < 0.001). The mean calculated elimination rate constant was higher than the predicted value (0.106 ± 0.03 vs. 0.079 ± 0.02 h−1; p < 0.001), and the mean calculated half-life was lower than predicted (7.2 ± 2.3 vs. 9.6 ± 3.2 h; p < 0.001).

Conclusions

Patients with hemorrhagic stroke exhibited pharmacokinetic alterations favoring increased elimination of vancomycin when compared to predicted pharmacokinetic parameters based on population data. This may result in underexposure to vancomycin, leading to treatment failure and other medical complications.

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Authors and Affiliations

  1. Department of Pharmacy, UNC Health Care, Chapel Hill, NC, USA

    Kathryn A. Morbitzer, Kelly A. Sullivan & Emily A. Durr

  2. Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, 115 Beard Hall, Campus Box 7574, Chapel Hill, NC, 27599, USA

    Kathryn A. Morbitzer, Emily A. Durr & Denise H. Rhoney

  3. Departments of Neurology and Neurosurgery, University of North Carolina School of Medicine, Chapel Hill, NC, USA

    J. Dedrick Jordan & Casey M. Olm-Shipman

Authors
  1. Kathryn A. Morbitzer
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  2. J. Dedrick Jordan
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  3. Kelly A. Sullivan
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  4. Emily A. Durr
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  5. Casey M. Olm-Shipman
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  6. Denise H. Rhoney
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Correspondence to Denise H. Rhoney.

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The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The IRB at the University of North Carolina at Chapel Hill granted a waiver of informed consent for the study procedures.

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Morbitzer, K.A., Jordan, J.D., Sullivan, K.A. et al. Vancomycin Pharmacokinetic Parameters in Patients with Hemorrhagic Stroke. Neurocrit Care 25, 250–257 (2016). https://doi.org/10.1007/s12028-016-0264-8

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  • DOI: https://doi.org/10.1007/s12028-016-0264-8

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