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Impact of weight-based dosing on vancomycin dosing and trough levels

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Item Summary

Title: Impact of weight-based dosing on vancomycin dosing and trough levels
Authors: Bello, Erlaine F.
Keywords: obese
Issue Date: May 2014
Publisher: [Honolulu] : [University of Hawaii at Manoa], [May 2014]
Abstract: Background: In 2009, the American Society of Health System Pharmacists (ASHSP), Infectious Diseases Society of America (IDSA) and Society of the Infectious Diseases Pharmacists (SI DP) released a consensus statement on vancomycin dosing and monitoring. The appropriateness of these guidelines for a local population, particularly the subset of obese patients, has not been well-studied.
Methods: A retrospective chart review was conducted on patients hospitalized at an acute care, university-affiliated, community hospital who received intravenous vancomycin for suspected/documented infections prior to and after implementation of the 2009 guidelines. Preguidelines, patient received vancomycin, 1 gram every 12 hours. After the guidelines were implemented, patients were dosed on actual body weight (ABW), lS-20mg/kg, or 2S-30mg/kg in seriously ill patients, every 8-12 hours. We compared the frequency of achieving therapeutic troughs, nephrotoxicity and trough group levels stratified by Body Mass Index (BMI).
Results: There were no significant differences in achieving therapeutic troughs and nephrotoxicity. But when adjusted for BM I, was a significant difference in proportion of trough levels when between the two groups, p=0.0109. However, a large number of patients in the conventionally-dosed group were excluded due to inconsistent dosing. In the ABW-dosed group, there was a high number of supratherapeutic trough levels in 48% of patients with BMls >3S, p=O.OOS Conclusions: Obese patients may require an alternate dosing strategy as the ABW-dosing based on the 2009 national guidelines resulted in supra-therapeutic levels in patients with high BMls. Implementing guidelines-based monitoring resulted in more consistently and appropriately drawn trough levels.
Description: M.S. University of Hawaii at Manoa 2014.
Includes bibliographical references.
Rights: All UHM dissertations and theses are protected by copyright. They may be viewed from this source for any purpose, but reproduction or distribution in any format is prohibited without written permission from the copyright owner.
Appears in Collections:M.S. - Biomedical Sciences

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