Pharmacotherapy 2020-Jan
Vancomycin Pharmacokinetics in Obese Patients with Sepsis or Septic Shock.
কেবল নিবন্ধিত ব্যবহারকারীরা নিবন্ধগুলি অনুবাদ করতে পারবেন
প্রবেশ করুন - নিবন্ধন করুন
লিঙ্কটি ক্লিপবোর্ডে সংরক্ষিত হয়েছে
কীওয়ার্ডস
বিমূর্ত
PATIENTS
Sixteen obese (body mass index ≥30 kg/m2 ) adults with sepsis and either a gram-positive bacteremia or requiring vasopressor support (septic shock), who were receiving vancomycin between November 2016 and June 2018, were included. Patients were excluded if they were receiving renal replacement therapy or extracorporeal membrane oxygenation, treatment for central nervous system infections, pregnant or receiving vancomycin for surgical prophylaxis.MEASUREMENTS AND MAIN RESULTS
A population pharmacokinetic model was developed to describe vancomycin concentrations over time. Simulations to determine optimal dosing were performed using the pharmacokinetic model with different ranges of creatinine clearance (CrCl) and different vancomycin daily doses. Median age of the patients was 62 years; median body mass index was 36.1 kg/m2 , Acute Physiology and Chronic Health Evaluation (APACHE) II score was 26, and Sequential Organ Failure Assessment (SOFA) score was 11. Eleven patients (69%) had an acute kidney injury. Median initial vancomycin dose was 15 mg/kg; median vancomycin trough concentration was 17 mg/L. A one-compartment model best characterized the pharmacokinetics of vancomycin in obese patients with sepsis or septic shock. Volume of distribution was slightly increased in this population (0.8 L/kg) compared with the general population (0.7 L/kg). Only CrCl effect on drug clearance was found to be significant (decrease in the objective function value by 16.4 points), confirming that it is a strong predictor of vancomycin clearance.