title: Evaluation of Treatment Courses When Vancomycin Is Given Every 8 Hours in Adult Patients.
abstract: BACKGROUND
  Several nomograms include recommendations to give intravenous (IV) vancomycin at 8-hour dosing intervals (Q8H). However, there is a lack of detailed data regarding this dosing recommendation.
  
  
  METHODS
  A retrospective chart review of 100 patients who received 107 treatment courses of vancomycin Q8H for at least 5 days was performed. Distribution of vancomycin trough levels and rate of nephrotoxicity were evaluated.
  
  
  RESULTS
  Median patient age was 38 years (interquartile range [IQR] 27-50 years), median weight was 67 kg (IQR 55-79 kg), and median creatinine clearance was 124 mL/min (IQR 101-147 mL/min). Median duration of Q8H dosing was 9 days (IQR 7-12 days). Within the initial 96 hours, only 7% (7 of 104) of maximum trough concentrations were >20 mg/L (median dose 15 mg/kg [IQR 15-18 mg/kg]). After 96 hours of Q8H dosing, 34% (30 of 89) of maximum troughs were >20 mg/L (median dose 17 mg/kg [IQR 15-20 mg/kg]), P = .0005. The rate of nephrotoxicity was 4%.
  
  
  CONCLUSIONS
  We observed an increase in the percentage of trough levels >20 mg/L later during treatment courses of vancomycin IV Q8H with a relatively small corresponding increase in vancomycin dose. Close monitoring of trough levels (eg, every 3 days) with prolonged courses of vancomycin IV Q8H is warranted.
authors.affiliation: Department of Pharmacy, NYU Langone Medical Center, New York, NY, USA.
authors.forename: Erica
authors.initials: E
authors.lastname: Brumer
authors.affiliation: Department of Pharmacy, NYU Langone Medical Center, New York, NY, USA yanina.dubrovskaya@nyumc.org.
authors.forename: Yanina
authors.initials: Y
authors.lastname: Dubrovskaya
authors.affiliation: Department of Pharmacy, NYU Langone Medical Center, New York, NY, USA.
authors.forename: Marco R
authors.initials: MR
authors.lastname: Scipione
authors.affiliation: Department of Pharmacy, NYU Langone Medical Center, New York, NY, USA.
authors.forename: Caitlin
authors.initials: C
authors.lastname: Aberle
authors.affiliation: Division of Infectious Diseases, Department of Medicine, NYU Langone Medical Center, New York, NY, USA.
authors.forename: Joseph
authors.initials: J
authors.lastname: Rahimian
authors.affiliation: Department of Pharmacy, NYU Langone Medical Center, New York, NY, USA.
authors.forename: John
authors.initials: J
authors.lastname: Papadopoulos
mesh_terms: D061605:Administration, Intravenous; D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000097:blood / Q000627:therapeutic use; D004334:Drug Administration Schedule; D016903:Drug Monitoring; D005260:Female; D006801:Humans; D007674:Kidney Diseases / Q000139:chemically induced*; D008297:Male; D016920:Meningitis, Bacterial / Q000188:drug therapy; D008875:Middle Aged; D012189:Retrospective Studies; D012772:Shock, Septic / Q000188:drug therapy; D014640:Vancomycin / Q000008:administration & dosage* / Q000009:adverse effects / Q000097:blood / Q000627:therapeutic use*; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D014640:Vancomycin
keywords: dosing; nephrotoxicity; staphylococcus aureus; therapeutic monitoring; vancomycin