title: Evaluation of three methods for determining initial vancomycin doses.
abstract: Dosing methods proposed by Matzke et al., Moellering et al., and Lake and Peterson were used to predict initial doses of vancomycin for serum concentration simulation using a two-compartment open model. Previously reported pharmacokinetic data from 25 of 28 patients were used to simulate steady-state serum vancomycin concentrations for doses derived from the three methods. The Matzke method failed to provide simulated one-hour postinfusion levels less than 30 micrograms/mL in 48 percent and troughs greater than 5 micrograms/mL in more than 88 percent of the patients. The Moellering method succeeded in achieving this goal in 96 percent of the simulated one-hour levels, and in 72 percent of the troughs when a six-hour dosing interval was selected. For the 8 mg/kg Lake-Peterson doses, one-hour levels greater than 30 micrograms/mL occurred in 28 percent of the simulations, and for the 10 mg/kg doses this increased to 40 percent. The 8 mg/kg doses resulted in trough simulations less than 5 micrograms/mL in 28 percent and the 10 mg/kg reduced this to only 20 percent. These simulations indicated that the Moellering nomogram with the six-hour dosing interval was the most successful method for initial dose selection, but early serum concentration monitoring and adjustment of initial empirical and nomogram-derived doses is necessary to assure safe and effective vancomycin serum concentrations.
authors.affiliation: Department of Pharmacy Practice, College of Pharmacy, University of Arkansas for Medical Sciences, Little Rock 72205.
authors.forename: B H
authors.initials: BH
authors.lastname: Ackerman
mesh_terms: D000704:Analysis of Variance; D006801:Humans; D008657:Metabolic Clearance Rate; D008954:Models, Biological; D014640:Vancomycin / Q000008:administration & dosage* / Q000097:blood
chemical_list: D014640:Vancomycin