Aleksandra Rymarz

BP Howden

Dorota Brodowska-Kania

Elżbieta Józefczak-Bergier

Małgorzata Dzierżanowska

Małgorzata Gomółka

MJ Rybak

Stanisław Niemczyk

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NEPHROLOGY - LETTER TO THE EDITORVancomycin dosing in patients undergoing maintenancehemodialysisAleksandra Rymarz • Dorota Brodowska-Kania •Małgorzata Gomo´łka • El _zbieta Jo´zefczak-Bergier •Małgorzata Dzier _zanowska • Stanisław NiemczykReceived: 2 February 2014 / Accepted: 24 March 2014 / Published online: 3 April 2014 The Author(s) 2014. This article is published with open access at Springerlink.comEditor,In recent years, increasing pathogen resistance for vanco-mycin has been observed. According to new recommen-dations, trough target levels for this drug should bebetween 15 and 20 lg/ml [1]. Concentrations lower than10 lg/ml can cause therapeutic failure and bring aboutvancomycin resistance [2]. To achieve this target, an initialdose of 20–25 mg/kg actual body weight is recommendedfor all patients.We examined 22 patients (5 female, 17 male), age64.32 ± 12.2 years, being treated with hemodialysis forend-stage renal disease between 2011 and 2012. The studyprotocol was approved by the Ethics Committee of MilitaryInstitute of Medicine. All patients were treated using a low-flux dialyzer of varying sizes three times a week for 3–4 h.Vascular accesses were as follows: cuffed catheters (16patients), noncuffed catheters (five patients) and arterio-venous fistula (one patient). Each patient received an initialdose of vancomycin 20 mg/kg actual dry body weight,rounded by 250 mg with an infusion rate 10 mg/min afterdialysis session. Vancomycin trough levels were deter-mined twice: 4 days after the initial dose and 4 days afterthe second dose. The second dose was related to plasmavancomycin concentration. If vancomycin concentrationwas at target level (15–20 lg/ml), the same dose wasrepeated. If concentration was lower than 15 lg/ml, thesecond dose was increased by 30 %. If vancomycin con-centration exceeded 20 lg/ml, a reduced dose wasadministered. Fluorescence polarization immunoassay test(Axsym system, Abbott) was used to assess plasma van-comycin concentration.The main reason for vancomycin administration wassepsis (20 patients, 90.9 %), in all cases related to catheter.The most frequent pathogen was methicillin resistantStaphylococcus aureus (13 patients, 72.2 %).Mean trough vancomycin concentration after the initialdose was 13.26 ± 4.46 lg/ml. Mean vancomycin dose peractual body weight was 20.62 ± 2.35 mg/kg. Mean firsttotal dose was 1,590.91 ± 342.98 mg. Six patients(27.2 %) achieved target trough levels of 15–20 lg/ml.Range 10–20 lg/ml achieved 72.7 % (16 patients). 15patients (68.1 %) had trough levels below 15 lg/ml,among them six patients (27.2 %) had levels below 10 lg/ml. Only one patient had concentration above 20(21.42 lg/ml).After the second dose, the mean trough level of this drugwas 20.73 ± 4.58 lg/ml. Mean vancomycin dose peractual body weight was 23.01 ± 10.11 mg/kg. Mean totalsecond dose was 1,777.78 ± 351.85 mg. Nine patients(40.9 %) had trough levels of 15–20 lg/ml. Two patientshad trough levels below 15 lg/ml, and no one fell below10 lg/ml. Eleven patients (50 %) had concentration above20 lg/ml, among them mean concentration was 23.42 lg/ml.Initial vancomycin doses in hemodialysis patientsshould be based on actual body weight; however, one-thirdof patients do not reach the recommended trough level of15–20 lg/ml. It seems reasonable that among certainpatients higher doses could be used. Subsequent doses ofthe drug should be related to its serum concentration, typeA. Rymarz (&)  D. Brodowska-Kania  M. Gomo´łka S. NiemczykDepartment of Internal Diseases, Nephrology and Dialysis,Military Institute of Medicine, Szasero´w 128, 04-141 Warsaw,Polande-mail: ola@rymarz.pl; arymarz@wim.mil.plE. Jo´zefczak-Bergier  M. Dzier _zanowskaDepartment of Laboratory Diagnostics, Military Institute ofMedicine, ul. Szasero´w 128, 04-141 Warsaw, Poland123Int Urol Nephrol (2014) 46:1681–1682DOI 10.1007/s11255-014-0707-0of membrane used in dialysis session and time of itsadministration. Vancomycin dosing protocol in hemodial-ysis patients requires further evaluation on larger groups ofpatients.Acknowledgments All authors of manuscript declare no conflict ofinterest. All authors agree with the content of manuscript. The paperhas not been published or submitted for publication elsewhere. Theprotocol for the research has been approved by the Ethics Committeeof Military Institute of Medicine.Open Access This article is distributed under the terms of theCreative Commons Attribution License which permits any use, dis-tribution, and reproduction in any medium, provided the originalauthor(s) and the source are credited.References1. Rybak MJ, Lomaestro BM, Rotscahfer JC et al (2009) Vancomy-cin therapeutic guidelines: a summary of consensus recommenda-tions from the Infectious Diseases Society of America, theAmerican Society of Health-System Pharmacists and the Societyof Infectious Diseases Pharmacists. Clin Infect Dis 49:325–3272. Howden BP, Ward PB, Charles PG et al (2004) Treatmentoutcomes for serious infection caused by methycillin-resistantStaphylococcus aureus with reduced vancomycin susceptibility.Clin Infect Dis 38:521–5281682 Int Urol Nephrol (2014) 46:1681–1682123

International Urology and Nephrology

Vancomycin dosing in patients undergoing maintenance hemodialysis

https://link.springer.com/content/pdf/10.1007%2Fs11255-014-0707-0.pdf

Vancomycin dosing in patients undergoing maintenance hemodialysis

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