Optimisation of vancomycin regimen in neutropenic haematological patients with normal renal function. Multiple daily doses may be preferable

Abstract

Objective: To assess the appropriateness, on a pharmacokinetic basis, of a twice-daily regimen of vancomycin 1 g in neutropenic patients with normal renal function, a regimen frequently used in the empirical treatment of this patient group. The study also used a Bayesian pharmacokinetic approach to predict vancomycin concentrations in order to determine the optimal dosage frequency of the drug (two or four daily doses) in this population. Patients and Methods: Data were collected retrospectively as part of routine therapeutic drug monitoring (TDM) of vancomycin in 16 adult neutropenic patients. TDM of vancomycin peak (C(max)) and trough (C(min)) serum concentrations was performed after twice daily administration of vancomycin 1 g as a 1-hour intravenous infusion for 48 hours. According to TDM results (C(min) 65 7 or MIC, an important determinant of vancomycin efficacy. However, because of interpatient variability, TDM of vancomycin is strongly recommended to individualise therapy in this subpopulation