Research Article: | Optimal vancomycin dosing regimens for critically ill patients with acute kidney injury during continuous renal replacement therapy: A Monte Carlo simulation study |
ผู้เขียน/Author: | Taniya Charoensareerat, Weerachai Chaijamorn, Apinya Boonpeng, Nattachai Srisawat, Chalermsri Pummangura & Sutthiporn Pattharachayakul |
Email: | taniya.cha@siam.edu |
Department/Faculty | Faculty of Pharmacy, Siam University, Bangkok 10160 |
Published/แหล่งเผยแพร่ | Journal of Critical Care, 54, 77-82. |
การอ้างอิง/citation
Taniya Charoensareerat, Weerachai Chaijamorn, Apinya Boonpeng, Apinya Boonpeng, Chalermsri Pummangura & Sutthiporn Pattharachayakul. (2019). Optimal vancomycin dosing regimens for critically ill patients with acute kidney injury during continuous renal replacement therapy: A Monte Carlo simulation study. Journal of Critical Care, 54, 77-82.
ABSTRACT
Purpose: This study aims to determine the optimal vancomycin dosing in critically ill patients with acute kidney injury receiving continuous renal replacement therapy (CRRT) using Monte Carlo simulation.
Methods: A one-compartment pharmacokinetic model was conducted to define vancomycin deposition for the initial 48hours of therapy. Pharmacokinetic parameters were gathered from previously published studies. The AUC24/MIC ratio of at least 400 and an average of AUC0-24 at N 700mgh/L was utilized to evaluate efficacy and nephrotoxicity, respectively. The doses achieved at least 90% of the probability of target attainment (PTA) with the lowest risk of nephrotoxicity defined as the optimal dose. Results: The regimens of 1.75grams every 24hours and 1.5grams loading followed by 500mg every 8hours were recommended for empirical therapy of an MRSA infection with expected MIC ≤1mg/L, and definite therapy with actual MIC of 1mg/L. The probabilities of nephrotoxic results from these regimens were 35%. Conclusions: A higher dose of vancomycin than the current literature-based recommendation was needed in CRRT patients.
Keywords: vancomycin continuous renal replacement therapy Monte Carlo simulations critically ill acute kidney injury.
Optimal vancomycin dosing regimens for critically ill patients with acute kidney injury during continuous renal replacement therapy: A Monte Carlo simulation study
Faculty of Pharmacy, Siam University, Bangkok, Thailand
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