title: High versus standard dose vancomycin for osteomyelitis.
abstract: It is important to identify the optimal dosage and best method of infusion of parenteral vancomycin to be used over a several week period for the treatment of osteomyelitis. A retrospective study was undertaken to compare a high dose vancomycin treatment (HD: 40 mg/kg/d) with a standard dose treatment (SD: 20 mg/kg/d), and also to compare the modality of infusion using either intermittent vancomycin infusion (IVI) or continuous vancomycin infusion (CVI). 89 patients with Gram-positive cocci osteomyelitis requiring vancomycin treatment were followed, and the outcome and therapeutic safety were compared. There were significantly more adverse drug reactions (acute renal failure) in the IVI subgroup (HD-IVI vs SD-IVI, p-value 0.007). No cases of renal failure were found in the HD-CVI subgroup. The best outcome was found in the subgroup of patients who received HD-CVI (HD-CVI vs SD-IVI, overall log rank p-value 0.02). HD-CVI treatment appears to provide an improved outcome with fewer adverse drug reactions.
authors.affiliation: Department of Medicine, Geneva University Hospital, Switzerland.
authors.forename: Emmanuelle
authors.initials: E
authors.lastname: Boffi El Amari
authors.forename: Albert
authors.initials: A
authors.lastname: Vuagnat
authors.forename: Richard
authors.initials: R
authors.lastname: Stern
authors.forename: Mathieu
authors.initials: M
authors.lastname: Assal
authors.forename: Philippe
authors.initials: P
authors.lastname: Denormandie
authors.forename: Pierre
authors.initials: P
authors.lastname: Hoffmeyer
authors.forename: Louis
authors.initials: L
authors.lastname: Bernard
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D004305:Dose-Response Relationship, Drug; D005260:Female; D005500:Follow-Up Studies; D016908:Gram-Positive Bacterial Infections / Q000175:diagnosis / Q000188:drug therapy*; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010019:Osteomyelitis / Q000188:drug therapy* / Q000382:microbiology* / Q000503:physiopathology; D011336:Probability; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D016896:Treatment Outcome; D014640:Vancomycin / Q000008:administration & dosage*
chemical_list: D014640:Vancomycin