Pharmacokinetics of and maintenance dose recommendations for vancomycin in severe pneumonia patients undergoing continuous venovenous hemofiltration with the combination of predilution and postdilution
Therapeutic vancomycin levels are difficult to maintain in severe pneumonia patients who are receiving IV vancomycin therapy while on continuous venovenous hemofiltration (CVVH). The objective of this study was to determine the pharmacokinetics and maintenance dose recommendations of vancomycin in severe pneumonia patients receiving CVVH.
A prospective study was conducted in the intensive care unit of a university hospital. Ten severe pneumonia patients receiving vancomycin and CVVH treatment were determined the initial and steady-state pharmacokinetics of vancomycin. CVVH was performed in mixed predilution and postdilution mode with a blood flow rate of 180 mL/min and an ultrafiltrate flow rate of 30–40 mL/kg/h. Group A received an initial dose of 500 mg only, whereas group B received 500 mg every 12 h until steady state is achieved. Serum and ultrafiltrate were collected over 12 h after infusion of vancomycin.
After initial dosing, the mean sieving coefficient (SC) was 0.72 ± 0.02, and CVVH clearance (CLCVVH, 1.35 ± 0.03 L/h) constituted 60.55% ± 13.69% of total vancomycin clearance (CLtot, 2.36 ± 0.72 L/h). When steady state was reached, the SC of the patients was 0.71 ± 0.03, and the CLCVVH (1.34 ± 0.06 L/h) accounted for 66.96% ± 6.05% of the CLtot (2.03 ± 0.27 L/h). The recommended maintenance dose for vancomycin in severe pneumonia patients was 400–650 mg every 12 h, which was calculated based on CLtot, to achieve a trough concentration of 15–20 mg/L at steady state.
Single administration or multiple administration does not affect SC and CLCVVH. Owing to therapeutic vancomycin levels is difficult to maintain in severe pneumonia patients who are receiving IV vancomycin therapy while on CVVH, close monitoring of serum trough concentrations is required.
KeywordsVancomycin Pharmacokinetics Continuous venovenous hemofiltration Severe pneumonia patients Dosing recommendations
QL and FL helped acquire, analyze, and interpret the data and drafted the article. WC and XL conceived and designed the study, helped analyze and interpret the data, and revised the article for publication. LS, PL, BL, and LT helped interpret the data and revised the article for publication. All authors had full access to all of the data and can take responsibility for the integrity of the data and the accuracy of the data analysis and had final approval of the version to be published.
This study was supported by the Guangdong Provincial Hospital Pharmacy Research Fund (No. 2014A11) and Doctor, Study Abroad Staff Research Fund (No. 2014C28) grant from Guangzhou Medical University, China.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
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.
Informed consent was obtained from all individual participants included in the study.
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