التفاصيل البيبلوغرافية
| العنوان: |
Comparison of Vancomycin Area-Under-the-Curve Dosing Versus Trough Target-Based Dosing in Obese and Nonobese Patients With Methicillin-Resistant Bacteremia. |
| المؤلفون: |
Covvey, Jordan R., Erickson, Olivia, Fiumara, David, Mazzei, Kelly, Moszczenski, Zachary, Slipak, Kelly, Nemecek, Branden D., Zimmerman, David E., Guarascio, Anthony J. |
| المصدر: |
Annals of Pharmacotherapy; Jul2020, Vol. 54 Issue 7, p644-651, 8p |
| مصطلحات موضوعية: |
VANCOMYCIN, METHICILLIN-resistant staphylococcus aureus, OBESITY, BACTEREMIA, BODY mass index, OBESITY complications, PHARMACOKINETICS, RETROSPECTIVE studies, STAPHYLOCOCCAL diseases, ANTIBIOTICS, LONGITUDINAL method, ACUTE kidney failure, MICROBIAL sensitivity tests, DISEASE complications |
| مستخلص: |
Background: A vancomycin target of area under the curve to minimum inhibitory concentration (AUC:MIC) ratio ≥400 is recommended for treatment of methicillin-resistant Staphylococcus aureus (MRSA) bacteremia. Objective: To evaluate vancomycin total daily dose (TDD) achieving trough targets versus a calculated strategy achieving AUC targets based on body mass index (BMI). Methods: A retrospective cohort study was performed within a large hospital network. Patients with MRSA bacteremia were eligible if they received vancomycin with a steady-state trough (15-20 mg/L). Cockcroft-Gault was used to estimate creatinine clearance, calculating vancomycin clearance and AUC. Patients were stratified by BMI (less than/greater than 30 kg/m2). The primary outcome was vancomycin TDD for the trough-based strategy compared with an AUC-dosing strategy. Results: A total of 119 patients were included, including 51 (42.9%) and 68 (57.1%) patients with high- and low-BMI, respectively. The TDD for trough-based dosing (2390.76 ± 1224.59 mg) differed significantly from AUC-based dosing (1985.07 ± 616.18 mg) across the cohort (P = 0.0014). For patients with high BMI, there was a significant difference (P < 0.0001) in TDD between trough (2637.25 ± 1327.89 mg) versus AUC (1918.71 ± 625.89 mg) strategies. No difference in TDD between dosing strategies was observed among low-BMI patients. Across all patients, 46 (38.7%) experienced acute kidney injury (AKI); high-BMI patients experienced higher rates of AKI compared with low-BMI patients (54.9 vs 26.5%; P = 0.002). Conclusions and Relevance: An AUC-based dosing strategy may reduce vancomycin TDD required for MRSA bacteremia compared with trough-based dosing, particularly for patients with higher BMI. [ABSTRACT FROM AUTHOR] |
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| قاعدة البيانات: |
Complementary Index |
