title: Evaluation of a vancomycin dosing nomogram based on the Modification of Diet in Renal Disease equation in intensive care unit patients.
abstract: OBJECTIVE
  The purpose of the study is to evaluate the effectiveness of a vancomycin nomogram using actual body weight and the Modification of Diet in Renal Disease equation to estimate renal function in intensive care unit patients.
  
  
  METHODS
  Retrospective evaluation (preimplementation group, n=57) was conducted from March 2011 to April 2011. Prospective evaluation was conducted after nomogram implementation (postimplementation group, n=60) from December 2011 to February 2012.
  
  
  RESULTS
  The percentage of patients with an initial vancomycin trough concentration 15 μg/mL or higher increased in the postimplementation group as compared with the preimplementation group (72% vs 39%, P=.0004). The postimplementation group also demonstrated an increase in the percentage of patients with initial trough concentration between 15 and 20 μg/mL (42% vs 19%, P=.0099), and no statistical difference in the percentage of patients with an initial trough greater than 20 μg/mL (30% vs 19%, P=.2041). There was no difference in nephrotoxicity in the postimplementation group compared with the preimplementation group (18% vs 17.5%, P=1.0).
  
  
  CONCLUSIONS
  Use of a vancomycin nomogram increased the percentage of initial vancomycin trough concentrations 15 μg/mL or higher in intensive care unit patients and was not associated with an increased occurrence of nephrotoxicity.
authors.affiliation: Department of Pharmacy, Massachusetts General Hospital, Boston, MA, 02114, USA.
authors.forename: Brandy S
authors.initials: BS
authors.lastname: Golenia
authors.forename: Alexander R
authors.initials: AR
authors.lastname: Levine
authors.forename: Iman M
authors.initials: IM
authors.lastname: Moawad
authors.forename: D Dante
authors.initials: DD
authors.lastname: Yeh
authors.forename: Paul A
authors.initials: PA
authors.lastname: Arpino
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000493:pharmacokinetics; D001835:Body Weight; D016638:Critical Illness; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D049451:Nomograms; D011446:Prospective Studies; D012189:Retrospective Studies; D014640:Vancomycin / Q000008:administration & dosage* / Q000493:pharmacokinetics
chemical_list: D000900:Anti-Bacterial Agents; D014640:Vancomycin
keywords: Antibiotics; Dosing nomogram; ICU; Vancomycin