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Population pharmacokinetics of vancomycin in patients with external ventricular drain‐associated ventriculitis
Author(s) -
Jalusic Kris Oliver,
Hempel Georg,
Arnemann PhilipHelge,
Spiekermann Christina,
Kampmeier TimGerald,
Ertmer Christian,
Gastine Silke,
Hessler Michael
Publication year - 2021
Publication title -
british journal of clinical pharmacology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.216
H-Index - 146
eISSN - 1365-2125
pISSN - 0306-5251
DOI - 10.1111/bcp.14657
Subject(s) - nonmem , pharmacokinetics , medicine , ventriculitis , vancomycin , population , external ventricular drain , trough concentration , renal function , elimination rate constant , area under the curve , dosing , cerebrospinal fluid , anesthesia , pharmacology , volume of distribution , environmental health , biology , bacteria , genetics , staphylococcus aureus
Background To determine the distribution of vancomycin into the cerebrospinal fluid (CSF) in patients with external ventricular drain (EVD)‐associated ventriculitis, the pharmacokinetics of vancomycin were evaluated and covariate relationships explored. Methods For the population pharmacokinetic model patients were recruited in a neurocritical care unit at the University Hospital of Muenster in the period between January 2014 and June 2015. All patients had a clinical evidence of EVD‐associated ventriculitis. Population pharmacokinetic analysis of vancomycin was performed using NONMEM. Results A total of 184 blood and 133 CSF samples were collected from 29 patients. The final population pharmacokinetic model is a three‐compartment model with linear elimination. Creatinine clearance (Cl Cr ) and CSF‐lactate were detected as significant covariates, showing that the total vancomycin plasma clearance (Cl) depends on Cl Cr and furthermore the clearance (Cl dif ) between the central and CSF compartment correlates with CSF lactate concentration. Based on the final model, the following values were estimated by NONMEM: Cl = 5.15 L/h, Q (intercompartmental clearance) = 3.31 L/h, Cl dif = 0.0031 L/h, V central = 42.1 L, V CSF = 0.32 L and the value of V peripheral was fixed to 86.2 L. With the developed pharmacokinetic model, area under the curve (AUC) values as well as CSF trough levels were simulated. Conclusion Based on our analysis, the dosing of vancomycin should be referred to the degree of inflammation (derived from the CSF lactate concentration) and renal function (derived from Cl Cr ).