In this episode, I’ll discuss empiric dosing of vancomycin for patients on CRRT.
A lower dose of vancomycin is recommended for use in patients receiving CRRT in common 3rd party medication references such as Lexi-Comp. However there is little published data available to base such dosing recommendations on. A group of authors recently added to the data available by publishing a retrospective cohort study in the journal Pharmacotherapy. The goal of the study was to determine vancomycin exposure target and dosing recommendations using data from an open database in critically ill patients undergoing CRRT.
The authors developed a population pharmacokinetic model using data from 180 patients. The model was then used to estimate individual pharmacokinetic (PK) parameters and a monte carlo simulation was used to develop dosing recommendations. Finally, multivariate logistic regression was used to identify the factors that influenced clinical outcomes.
After analysis was complete, the authors identified that the intensity of CRRT significantly affected vancomycin pharmacokinetics. When clinical efficacy was analyzed, an AUC above 427 mg/L was the only factor that predicted clinical efficacy.
For patients with CRRT intensities of 20–25 mL/kg/hr the authors recommend a vancomycin dose of 5 mg/kg IV every 12 hours and for those with CRRT intensities of 25.1–45 mL/kg/hr they recommend 7.5 mg/kg IV every 12 hours.
This study provides important context to the information needed to make a dosing decision for vancomycin in patients on CRRT as references had not previously recommended differing doses based on specific levels of CRRT intensity.
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