Published abstract from the 47th American Burn Association Annual Meeting. Chicago, IL April 2015

Buening, N. R.

Damer, Kendra M.

Erdman, S.

Foster, D. R.

Lavery, K. A.

Sood, R.

Walroth, T. A.

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Butler UniversityDigital Commons @ Butler UniversityScholarship and Professional Work – COPHS College of Pharmacy & Health Sciences2015Evaluation of a Vancomycin Dosing Protocol andPharmacokinetic Parameters in Burn PatientsT. A. WalrothK. A. LaveryS. ErdmanN. R. BueningD. R. FosterSee next page for additional authorsFollow this and additional works at: http://digitalcommons.butler.edu/cophs_papersPart of the Critical Care Commons, Pharmacy and Pharmaceutical Sciences Commons, and theTherapeutics CommonsThis Conference Proceeding is brought to you for free and open access by the College of Pharmacy & Health Sciences at Digital Commons @ ButlerUniversity. It has been accepted for inclusion in Scholarship and Professional Work – COPHS by an authorized administrator of Digital Commons @Butler University. For more information, please contact fgaede@butler.edu.Recommended CitationWalroth, T. A.; Lavery, K. A.; Erdman, S.; Buening, N. R.; Foster, D. R.; Damer, Kendra M.; and Sood, R., "Evaluation of a VancomycinDosing Protocol and Pharmacokinetic Parameters in Burn Patients" (2015). Scholarship and Professional Work – COPHS. Paper 230.http://digitalcommons.butler.edu/cophs_papers/230AuthorsT. A. Walroth, K. A. Lavery, S. Erdman, N. R. Buening, D. R. Foster, Kendra M. Damer, and R. SoodThis conference proceeding is available at Digital Commons @ Butler University: http://digitalcommons.butler.edu/cophs_papers/230Print this PagePresentation AbstractTitle: Evaluation of a Vancomycin Dosing Protocol and Pharmacokinetic Parameters in Burn PatientsAuthorBlock:T. A. Walroth, PharmD, BCPS, K. A. Lavery, PharmD, S. Erdman, PharmD, N. R. Buening, PharmD,BCPS, D. R. Foster, PharmD, K. M. Damer, PharmD, R. Sood, MD, FACSEskenazi Health, Indianapolis, IN; Stanford Hospital, Stanford, CA; Butler University, Indianapolis, INCategory: Critical Care – ClinicalAbstract: Introduction: Burn patients exhibit pharmacokinetic (PK) derangements requiring larger vancomycindoses to reach target serum concentrations. At our institution, vancomycin dosing is performed per apharmacy-to-dose protocol. The primary objective was to evaluate the effectiveness of this protocol inachieving target vancomycin trough concentrations (Ctr). Secondary objectives were to calculate patientspecific PK parameters and determine efficacy and safety of vancomycin use in this population.Methods: This retrospective, observational study included patients with ≥ 10% TBSA burn injury whoreceived vancomycin with at least one measured Ctr. Exclusion criteria were: < 18 years old, pregnant,prisoner, or at risk for or experiencing acute kidney injury upon vancomycin initiation or up to the time ofinitial Ctr. Steady state concentrations were used to determine percentage of patients who achieved targetCtr of 10-20 mcg/mL. Secondary endpoints included percentage of patients requiring dose adjustments orwith initial Ctr less than 10 or greater than 20 mcg/mL. PK parameters were calculated using steady-statepeak and trough concentrations when available. Efficacy and safety were evaluated by total daily dose,time to target Ctr, clinical outcomes, and reported adverse events.Results: Forty patients were screened from 07/01/13 - 02/28/14, with 13 included in the study. Mean ± SDTBSA was 39 ± 23, age was 51 ± 17 years, weight was 82 ± 23 kg, and 77% were male. During the courseof therapy, 11 (85%) patients achieved target Ctr, our primary endpoint. Median initial Ctr was 12.7(8.4-16.9) mcg/mL. In response to the first Ctr, 8 (62%) patients required a dosage adjustment. Mean PKparameters were calculated in subjects with measured peak and trough concentrations who were notreceiving renal replacement therapy. In these subjects (n=7), vancomycin clearance was 124 ± 60 mL/min,volume of distribution was 0.79 ± 0.23 L/kg, and half-life was 6.8 ± 2.5 hours. Average starting dose was37.1 ± 12.0 mg/kg/day and average dose to reach target Ctr was 44.3 ± 19.5 mg/kg/day. Median (IQR)time to target Ctr was 2 (2-3) days. Overall, 10 (77%) patients completed vancomycin therapy and weredischarged from the hospital. The remaining 3 (23%) patients died, but no deaths were attributed to grampositive infection. There was one case of nephrotoxicity, unrelated to vancomycin.Conclusions: Results are consistent with our previous research suggesting adult burn patients with normalrenal function require higher vancomycin doses. A pharmacy-to-dose protocol for vancomycin resulted ina majority of patients (85%) achieving target Ctr during therapy.Applicability of Research to Practice: This study highlights the benefit of a pharmacist-directedapproach to dosing and monitoring vancomycin in adult burn patients.Abstract Print View http://www.abstractsonline.com/Plan/AbstractPrintView.aspx?mID=370...1 of 1 8/15/2016 10:47 AM

Evaluation of a Vancomycin Dosing Protocol and Pharmacokinetic Parameters in Burn Patients

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Evaluation of a Vancomycin Dosing Protocol and Pharmacokinetic Parameters in Burn Patients

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