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Individualized Vancomycin Dosing in Obese Patients: A Two‐Sample Measurement Approach Improves Target Attainment
Author(s) -
Hong Joseph,
Krop Lynne C.,
Johns Tracy,
Pai Manjunath P.
Publication year - 2015
Publication title -
pharmacotherapy: the journal of human pharmacology and drug therapy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.227
H-Index - 109
eISSN - 1875-9114
pISSN - 0277-0008
DOI - 10.1002/phar.1588
Subject(s) - dosing , medicine , vancomycin , trough concentration , percentile , body mass index , pharmacokinetics , therapeutic drug monitoring , trough level , pharmacodynamics , population , regimen , statistics , transplantation , mathematics , environmental health , tacrolimus , biology , bacteria , genetics , staphylococcus aureus
Study Objective To compare the likelihood of vancomycin target trough concentration attainment based on infectious diagnosis and/or minimum inhibitory concentration for the organism by using a two‐sample approach versus the prior institutional standard of a trough‐only approach in obese patients receiving vancomycin. Design Preintervention and postintervention study. Setting Community acute care hospital. Patients One hundred fifty hospitalized adults with a body mass index ( BMI ) of 30 kg/m 2 or greater and treated with vancomycin for at least 48 hours between July 2013 and March 2014 were evaluated to compare the frequency of steady‐state therapeutic trough concentration attainment between two approaches: a trough‐only dosing method (preintervention group [75 patients]) and a dosing strategy measuring two vancomycin serum concentrations during the elimination phase (peak and trough) to calculate pharmacokinetic parameters and individualize the maintenance regimen (postintervention group [75 patients]). Data for the preintervention group were retrospectively retrieved from a 4‐month period for patients admitted between J uly and O ctober 2013, prior to implementation of the two‐point vancomycin dosing protocol. Initial vancomycin empiric dose selection for both groups utilized the same population‐based pharmacokinetic equations. Measurements and Main Results Median (5th–95th percentile) age, weight, and BMI were 59 (34–80) years, 105 (79.8–164) kg, and 34.5 (30.0–55.1) kg/m 2 , respectively, for all patients. The percentages of initial therapeutic trough concentrations achieved in the preintervention and postintervention groups were 32.0% and 42.7%, respectively (p=0.117). For patients with a second trough measurement, 31.0% in the preintervention group and 65.2% in the postintervention group were within the therapeutic range (p=0.024). Conclusion Measurement of two serum vancomycin concentrations significantly improves subsequent target trough concentration attainment in the obese population.