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How vancomycin is used in Australasia – A survey
Author(s) -
Duffull S. B.,
Chambers S. T.,
Begg E. J.
Publication year - 1993
Publication title -
australian and new zealand journal of medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.596
H-Index - 70
eISSN - 1445-5994
pISSN - 0004-8291
DOI - 10.1111/j.1445-5994.1993.tb04723.x
Subject(s) - dosing , vancomycin , medicine , trough concentration , serum concentration , pharmacokinetics , zoology , biology , bacteria , genetics , staphylococcus aureus
Background : Vancomycin serum concentrations have been monitored over the last 30 years in an attempt to avoid dose‐dependent toxicity and enhance efficacy. Current literature recommendations for peak and trough concentrations are usually in the range of 20–40 mg/L and 5–10 mg/L, respectively. Literature recommendations regarding the time at which peak concentrations are measured are highly variable, ranging from immediately after the end of the infusion to three hours post‐dose. Aims : To identify how vancomycin dosing is being monitored and assess variability in the current practice. Methods : A survey of microbiology departments and infectious disease physicians in major Australasian hospitals was undertaken. The variability in the current practice was assessed by fitting mean recommendations to a two compartment Bayesian model. Results : Of the 83 (70%) who replied 71 (86%) monitored vancomycin concentrations. Fifty‐four percent targeted peak concentrations within the range of 20–40 mg/L, and 73% targeted trough concentrations ≤ 10 mg/L. The time of sampling of peak concentrations varied considerably ranging from immediately (12%) to 120 minutes (12%) post‐infusion (median 30 minutes [40%]). The concentration‐time curves resulting from three sets of mean recommendations (“peaks' drawn at: 0, 30 and 120 minutes aiming for a concentration of 35 mg/L with a trough concentration of 10 mg/L) were modelled using a two compartment Bayesian programme. The predicted true peak (maximum) concentrations ranged from 30 to 86 mg/L, despite aiming for identical target concentrations, indicating marked variation in the actual dosing practice. Conclusions : There is thus considerable variation in the practice of vancomycin therapeutic monitoring which has a major effect on dosing. The main contributing factor is the variable timing of sampling peak concentrations. (Aust NZ J Med 1993; 23: 662–666.)