Therapeutic drug monitoring for continuous infusion of vancomycin in critically ill patients
| dc.contributor.advisor | Spruyt, M. G. L. | |
| dc.contributor.author | Van den Heever, T. | |
| dc.date.accessioned | 2016-12-13T09:49:40Z | |
| dc.date.available | 2016-12-13T09:49:40Z | |
| dc.date.issued | 2011 | |
| dc.description.abstract | 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. | en_ZA |
| dc.description.abstract | Afrikaans: Inleiding Daar is huidiglik wynig studies gepubliseer oor die monitoring van ‘n deurlopende infuus van vancomycin. Hierdie studie bewys dat terapeutiese vlakke van 15 – 20 mg/L effektief is in die behandeling van gram positiewe infeksies. Gelykvlak in die weefsel word bereik as terapeutiese vlakke van 15 – 20 mg/L bereik word. ‘n Ladings dosering van 15 mg/kg word aanbeveel ongeag die nierfunksie. Vir pasïente met geen nierfunskie inkorting nie word ‘n instandhoudings dosering van 30 mg/kg aanbeveel. Hierdie studie is oor ‘n kort tydperk uitgevoer en geen nefrotoksisiteit is waargeneem nie. Metodes ‘n Prospektiewe analitiese studie met 10 pasïente wat aan die insluitingskriteria voldoen het, is in die studie ingelsuit. Die studie is gedoen in die Multidissiplinere Intensiewe Sorg Eenheid te Universitas hospitaal. Resultate was opgesom met behulp van standaard deviasies of persentiele (numeriese veranderlikes), frekwensies en persentasies (kategoriese veranderlikes). Die distribusie volume was gebruik om die instandhoudings dosering van vancomycin aan te pas, in orde om ‘n terapeutiese plasma vlak van 15 – 20 mg/L te verkry. Die ladingsdosereing wat gebruik is, is 15 mg/kg opgelos in 200ml 5% Dextrose water. Die ladingsdosering is oor ‘n tydperk van twee ure toegedien. Onmiddelik na die ladingsdosering is die instandhoudings infuus van 30 mg/kg in 200ml 5% dextrose water teen 8 ml per uur begin. Resultate Van die dertien pasïente het slegs tien aan die insluitingskriteria voldoen. Na die ladingsdosering was die gemiddelde vlak 34,9 mg/L. Die gemiddelde konsentrasie na die eerste, tweede en derde tydsinterval was tussen 15 – 20 mg/L. Die gemiddelde tydsduur om ‘n terapeutiese vlak van 15 – 20 mg/L te bereik was 21 uur. Die gemene elliminasie konstante van 0.150 was bewys om die mees effektiefste te wees in orde om terapeutiese vlakke te bereik. As die elliminasie konstante meer as 0.150 was dan moes die instandhoudings dosering verminder word, en vice versa. Die gemiddelde hoeveelheid vancomycin wat toegedien was om tereaputiese vlakke te bereik was 3 282 mg. Doel Om navolginswaardige riglyne te toets in orde om tereapeutiese vlakke van 15 – 20 mg/L te bereik. Gevolgtrekking Vir die optimalisering van behandeling van die kritiek siek pasïent is dit belangrik om navolginswaardige protokolle vir elke institusie op te stel en na te volg. Vir vancomycin word ‘n ladingsdosering van 15 mg/kg, opgelos in 200ml 5% dextrose water wat toegedien word oor ‘n tydperk van 2 ure aanbeveel. ‘n Instandhoudings infuus wat bestaan uit 30 mg/kg opgelos in 200ml 5% Dextrose water word aanbeveel. In orde om die regte dosering te bereken word ‘n distribusie volume van 0.72 l/kg aanbeveel as die kreatinine opruiming meer as 60 ml/min is. Vir ingekorte nierfunksie word ‘n distribusie volume van 0.89 l/kg aanbeveel as die kreainien opruiming 10 – 60 ml/min is. As die kreatinien opruiming minder as tien is dan word ‘n distrubusie volume van 0.9 l/kg aanbeveel. Die studie bewys dat dit moontlik is om met behulp van farmakodinamika en farmakokinetika parameters, gelykvlak te bereik en dat dit volhoubaar is. Dit het die gevolg dat tyd- en koste effektiewe behandeling van pasïente met sensitiewe gram positiewe infeksies vir vancomycin, moontlik is. | af |
| dc.identifier.uri | http://hdl.handle.net/11660/5229 | |
| dc.language.iso | en | en_ZA |
| dc.publisher | University of the Free State | en_ZA |
| dc.rights.holder | University of the Free State | en_ZA |
| dc.subject | Dissertation (M.Med.Sc. (Critical Care))--University of the Free State, 2011 | en_ZA |
| dc.subject | Critically ill -- Care | en_ZA |
| dc.subject | Vancomycin | en_ZA |
| dc.subject | Infusion therapy | en_ZA |
| dc.subject | Drug monitoring | en_ZA |
| dc.title | Therapeutic drug monitoring for continuous infusion of vancomycin in critically ill patients | en_ZA |
| dc.type | Dissertation | en_ZA |