A simple method for administering vancomycin in the spinal cord injured population.
OBJECTIVE
To examine the applicability in patients with spinal cord injury (SCI) of a modified version of the commonly used Lake and Peterson dosing regimen for vancomycin.


METHODS
Nonrandomized, prospective clinical trial with a historical control.


METHODS
Spinal cord injury unit at a Veterans Affairs Medical Center.


METHODS
Hospitalized patients with a history of SCI at least 6 months earlier and an estimated creatinine clearance of > or = 15 mL/min who required vancomycin therapy. The experimental group consisted of 15 evaluable patients, 8 with tetraplegia and 7 with paraplegia.


METHODS
Vancomycin regimens were initiated using a modified version of the guidelines of Lake and Peterson.


METHODS
After 4 to 8 doses, peak vancomycin concentrations in serum were obtained 15 minutes after a 1-hour infusion, and trough concentrations were drawn within 30 minutes of the next scheduled dose.


RESULTS
Only 3 of 15 (20%) patients in the experimental group required a single adjustment in the dosing interval to achieve the targeted serum vancomycin concentrations. The proportion of patients who required dosing modification was significantly lower in the experimental group than in a group of 16 SCI control patients who received vancomycin according to the dosing recommendations in the drug insert (20% vs 75%, respectively; p = .002).


CONCLUSIONS
These results support the need for tailored vancomycin dosing in the SCI population and the efficacy of this simple method of administering vancomycin in achieving desirable concentrations of vancomycin in the serum of SCI patients.
Griver
A R
AR
Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA.
Prince
R A
RA
Darouiche
R O
RO
D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000097:blood; D003404:Creatinine / Q000097:blood; D006801:Humans; D008875:Middle Aged; D011446:Prospective Studies; D013119:Spinal Cord Injuries / Q000097:blood / Q000378:metabolism*; D014640:Vancomycin / Q000008:administration & dosage* / Q000097:blood
D000900:Anti-Bacterial Agents; D014640:Vancomycin; D003404:Creatinine