title: Pharmacokinetic parameters of vancomycin for therapeutic regimens in neutropenic adult patients.
abstract: Vancomycin (V) is widely used in neutropenic patients, though its kinetics are known in this type of patient. In the present study, ten patients were included: all of them received an intensive therapy for non-Hodgkin malignant lymphoma, Hodgkin disease, myeloma, acute leukemia, followed by an autologous bone marrow transplantation in 6 cases. All patients were neutropenic (100/mm3). The pharmacokinetic study was done at the first V administration: 1000 mg V were injected as a 1-h infusion. Plasma V concentrations were measured by an enzyme immunoassay (EMIT, Syva, France). V maximal and minimal concentrations were 61.3 +/- 38.6 micrograms/ml and 1.69 +/- 0.77 microgram/ml, respectively. Total V clearance was 158 +/- 51 ml/min, with a creatinine clearance of 141.2 +/- 36.2 ml/min on test day. V plasma kinetics can be described by a biexponential model, with the following parameters: [table: see text] These data show a 3-fold increase of initial volume of distribution and a shortened (3-fold) T1/2 beta, if compared to values obtained in normal subjects. Because the bactericidal effect is time dependent, there can be a risk of insufficient antibiotic effect throughout the day. Our data suggest that new therapeutic regimens are needed for these patients.
authors.affiliation: Faculté de Médecine, Nantes, France.
authors.forename: Y
authors.initials: Y
authors.lastname: Le Normand
authors.forename: N
authors.initials: N
authors.lastname: Milpied
authors.forename: M F
authors.initials: MF
authors.lastname: Kergueris
authors.forename: J L
authors.initials: JL
authors.lastname: Harousseau
mesh_terms: D000293:Adolescent; D000328:Adult; D003404:Creatinine / Q000097:blood; D004360:Drug Therapy, Computer-Assisted; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000188:drug therapy; D006689:Hodgkin Disease; D006801:Humans; D007262:Infusions, Intravenous; D008228:Lymphoma, Non-Hodgkin; D008297:Male; D008657:Metabolic Clearance Rate; D008875:Middle Aged; D009503:Neutropenia / Q000150:complications*; D014640:Vancomycin / Q000097:blood / Q000493:pharmacokinetics* / Q000627:therapeutic use
chemical_list: D014640:Vancomycin; D003404:Creatinine