Masters Degrees (Critical Care)
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Browsing Masters Degrees (Critical Care) by Subject "Drug monitoring"
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Item Open Access Therapeutic drug monitoring for continuous infusion of vancomycin in critically ill patients(University of the Free State, 2011) Van den Heever, T.; Spruyt, M. G. L.English: Introduction Studies on therapeutic drug monitoring for continuous infusion of vancomycin in critically ill patients are scant. It has been proven that therapeutic levels of 15 – 20 mg/L is effective in treating severe gram positive infections and if kept in this range the amount of drug entering in and out of the tissue are equal. A loading dose of 15mg/kg should be administered irrespective of the renal function. The maintenance infusion in non renal impaired patients should be 30mg/kg and adjusted on a daily basis according levels. This study was over a short period of time and no nephrotoxicity was detected. Methods A prospective analytical study of 10 consecutive patients meeting the inclusion criteria, admitted to the Multidisciplinary Intensive Care Unit at Universitas Hospital was applied. Results were summarised by means of standard deviations or percentiles (numerical variables), frequencies and percentages (categorical variables). The distribution volume was used to calculate the estimated dosage of vancomycin to be given in order to achieve a therapeutic plasma concentration, in the case of vancomycin 15 – 20 mg/L. A loading does of 15mg/kg in 200ml 5% dextrose water over a 2 hour period was administered. Immediately after the loading dose a constant infusion of 30mg/kg in 200ml 5% dextrose water was started at a rate of 8ml/hr ivi. Results Of the thirteen patients only ten met the inclusion criteria. After the loading dose the mean concentration was 34,9 mg/L. The mean concentration after the first, second and third time interval was between 15 – 20 mg/L. The mean time to reach therapeutic levels of 15 – 20 mg/L was 21 hours. A mean elimination constant of 0.150 was shown to be the most effective in obtaining therapeutic levels whilst on a constant vancomycin infusion. If the elimination constant was more than 0.150 then the maintenance dosage had to be reduced and vice versa. The mean total Vancomycin administered to reach therapeutic levels was 3 282mg. Aim To test a feasible regimen for adjusting maintenance of vancomycin infusion in the critically ill patient in order to reach therapeutic vancomycin levels (15 – 20 mg/L) after commencement. Conclusion To optimise treatment of the critically ill patient institution-specific protocols need to be instituted. For vancomycin, a loading dose of 15mg/kg and a continuous infusion of 30mg/kg in 200ml 5% dextrose water are advisable to keep the concentration 15 – 20 mg/L. A distribution volume of 0,72 l/kg should be used for patients with a creatinine clearance above 60 ml/min. For patients with impaired renal function different distribution volumes are advisable. If the creatinine clearance is between 10 – 60 ml/min then a distribution volume of 0.89 l/kg is advisable. If the creatinine clearance is less than 10 ml/min then a distribution volume of 0.9 l/kg is advisable. These distribution volumes should be used to adjust the maintenance infusion accordingly. This study shows that with known pharmacodynamic and pharmacokinetic parameters it is possible to maintain a steady state with a continuous vancomycin infusion. This would lead to more time- and cost- effective treatment for patients with Vancomycin sensitive organisms.