title: Vancomycin clearance in high-volume venovenous hemofiltration.
abstract: OBJECTIVE
  To report the pharmacokinetic and pharmacodynamic properties of vancomycin in 4 patients undergoing high-volume continuous venovenous hemofiltration (CVVH).
  
  
  METHODS
  Data from 4 patients prescribed high-volume CVVH for acute renal failure treated with vancomycin were analyzed. Vancomycin plasma concentrations were measured 4 and 24 hours after the end of a 1-hour vancomycin infusion. The mean therapy fluid rate on initiation of vancomycin was 56.2 mL/kg/h (range 48.0-65.5). The mean loading dose of vancomycin was 18.3 mg/kg (range 14.7-19.7). Median vancomycin concentration 4 hours after the dose was 18.1 mg/L (range 13.1-30.0). At 24 hours after the dose, only 1 patient had a detectable vancomycin concentration (5.2 mg/L).
  
  
  CONCLUSIONS
  There was a large variability in the clearance of vancomycin in this patient population. Current strategies for dosing vancomycin may lead to subtherapeutic trough concentrations. Vancomycin dosing in this patient population should be based on a detailed assessment of the CVVH prescription, vancomycin concentrations, and clinical needs and response.
  
  
  CONCLUSIONS
  An initial vancomycin dose of 20-25 mg/kg with frequent monitoring and adjustment is recommended for patients receiving high-volume CVVH.
authors: Department of Pharmaceutical Services, Emory University Hospital, Atlanta, GA, USA. Christopher.paciullo@emoryhealthcare.org
authors: Christopher A
authors: CA
authors: Paciullo
authors: Kevin C
authors: KC
authors: Harned
authors: George A
authors: GA
authors: Davis
authors: Michael J
authors: MJ
authors: Connor
authors: P Shane
authors: PS
authors: Winstead
mesh_terms: D058186:Acute Kidney Injury / Q000097:blood / Q000628:therapy; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000097:blood / Q000493:pharmacokinetics*; D005260:Female; D006440:Hemofiltration; D006801:Humans; D008297:Male; D008875:Middle Aged; D014640:Vancomycin / Q000008:administration & dosage / Q000097:blood / Q000493:pharmacokinetics*
chemical_list: D000900:Anti-Bacterial Agents; D014640:Vancomycin