title: Vancomycin clearance during continuous venovenous haemofiltration in critically ill patients.
abstract: The objective of this study was to determine the pharmacokinetics and dosing recommendations of vancomycin in critically ill patients receiving continuous venovenous haemofiltration (CVVH). A prospective study was conducted in the Intensive Care Unit of a university hospital. Seven patients receiving CVVH with a triacetate hollow-fibre dialyser were enrolled. CVVH was performed in pre-dilution mode with a blood flow rate of 200-250 mL/min and an ultrafiltrate flow rate of 800-1200 mL/h. To determine vancomycin pharmacokinetics, serum and ultrafiltrate were collected over 12 h after a 2-h infusion of 1000 mg vancomycin. The mean (± standard deviation) sieving coefficient of vancomycin was 0.71±0.13, which is consistent with previously reported values. Clearance of vancomycin by CVVH (0.73±0.21 L/h or 12.11±3.50 mL/min) constituted 49.4±20.8% of total vancomycin clearance (1.59±0.47 L/h) and was consistent with previously reported clearances. Approximately one-fifth of the vancomycin dose was removed during the 12-h CVVH (213.9±104.0 mg). The volume of distribution was 24.69±11.00 L, which is smaller than previously reported. The elimination rate constant and terminal half-life were 0.08±0.05 h(-1) and 12.02±7.00 h, respectively. In conclusion, elimination of vancomycin by CVVH contributed to ca. 50% of the total elimination in critically ill patients. The maintenance dose of vancomycin, calculated from parameters from patients in this study, would be 500-750 mg every 12 h to provide a steady-state trough concentration of 15-20 mg/L. Owing to alterations in clinical conditions, serum vancomycin concentrations must be closely monitored in critically ill patients.
authors.affiliation: Faculty of Pharmacy, Siam University, Bangkok 10160, Thailand. zernpharm@yahoo.com
authors.forename: Weerachai
authors.initials: W
authors.lastname: Chaijamorn
authors.forename: Arnurai
authors.initials: A
authors.lastname: Jitsurong
authors.forename: Kamonthip
authors.initials: K
authors.lastname: Wiwattanawongsa
authors.forename: Usanee
authors.initials: U
authors.lastname: Wanakamanee
authors.forename: Phongsak
authors.initials: P
authors.lastname: Dandecha
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000378:metabolism / Q000493:pharmacokinetics*; D016638:Critical Illness; D017583:Hemodiafiltration / Q000379:methods*; D006801:Humans; D008297:Male; D008657:Metabolic Clearance Rate; D008875:Middle Aged; D011446:Prospective Studies; D014640:Vancomycin / Q000008:administration & dosage* / Q000378:metabolism / Q000493:pharmacokinetics*
chemical_list: D000900:Anti-Bacterial Agents; D014640:Vancomycin