Once-weekly vancomycin for patients receiving high-flux hemodialysis.
OBJECTIVE
The effectiveness of a once-weekly vancomycin dosing protocol for patients receiving long-term high-flux hemodialysis (HFHD) in the outpatient setting was studied.


METHODS
Eligible patients were at least 18 years old, required hemodialysis for at least two months before study enrollment, and were not known to have any active infection. All patients received outpatient dialysis at a 1000-bed urban teaching hospital three times per week through a high-flux synthetic dialyzer. All patients received vancomycin 35 mg/kg, rounded to the nearest 250 mg, administered during hemodialysis at a rate of 1 g/hr via an infusion pump and scheduled to end when the hemodialysis session was over. Vancomycin was infused either predialyzer or postdialyzer, and infusion pumps were used in patients who received vancomycin through the postdialyzer access port. Serum vancomycin levels were measured before the third hemodialysis session (study day 8) to evaluate the percentage of patients who maintained therapeutic vancomycin concentrations of >or=10 microg/mL.


RESULTS
No patients achieved a vancomycin concentration of >or=10 microg/mL on study day 8 (mean serum concentration, 5.1 microg/mL). When patients were separated into two groups based on administration technique, six patients (83%) who received vancomycin predialyzer had undetectable vancomycin levels (<3.5 microg/mL) by study day 8 (n = 6). Patients who received vancomycin postdialyzer maintained a mean serum concentration of 6.4 microg/mL at day 8 (n = 3).


CONCLUSIONS
A single dose of vancomycin 35 mg/kg administered during HFHD in oliguric patients with end-stage renal disease did not achieve the therapeutic serum concentration necessary for once-weekly dosing.
Crawford
Brooke S
BS
Department of Pharmacy, The Ohio State University Medical Center, Columbus, OH 43210, USA. bksorgen@hotmail.com
Largen
Rebecca F
RF
Walton
Ted
T
Doran
John J
JJ
D000328:Adult; D000553:Ambulatory Care; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000032:analysis / Q000097:blood; D005260:Female; D005845:Georgia; D006801:Humans; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000295:instrumentation / Q000379:methods*; D051437:Renal Insufficiency; D016896:Treatment Outcome; D014640:Vancomycin / Q000008:administration & dosage* / Q000032:analysis / Q000097:blood
D000900:Anti-Bacterial Agents; D014640:Vancomycin