title: Initial dosing regimen of vancomycin to achieve early therapeutic plasma concentration in critically ill patients with MRSA infection based on APACHE II score.
abstract: It is essential to assure the efficacy of antimicrobials at the initial phase of therapy. However, increasing the volume of distribution (Vd) of hydrophilic antimicrobials in critically ill patients leads to reduced antimicrobial concentration in plasma and tissue, which may adversely affect the efficacy of that therapy. The aim of the present study was to establish a theoretical methodology for setting an appropriate level for initial vancomycin therapy in individual patients based on Acute Physiology and Chronic Health Evaluation (APACHE) II score. We obtained data from patients who received intravenous vancomycin for a suspected or definitively diagnosed Gram-positive bacterial infection within 72 h after admission to the intensive care unit. The Vd and elimination half-life (t 1/2) of vancomycin values were calculated using the Bayesian method, and we investigated the relationship between them and APACHE II score. There were significant correlations between APACHE II scores and Vd/actual body weight (ABW), as well as t 1/2 (r = 0.58, p < 0.05 and r = 0.74, p < 0.01, respectively). Our results suggested that the Vd and t 1/2 of vancomycin could be estimated using the following regression equations using APACHE II score.[Formula: see text] [Formula: see text]We found that APACHE II score was a useful index for predicting the Vd and t 1/2 of vancomycin, and used that to establish an initial vancomycin dosing regimen comprised of initial dose and administration interval for individual patients.
authors.affiliation: Department of Clinical Evaluation of Drug Efficacy, School of Pharmacy, Tokyo University of Pharmacy and Life Sciences, 1432-1 Horinouchi, Hachioji, Tokyo, 192-0392, Japan.|Department of Pharmacy, Saiseikai Yokohamashi Tobu Hospital, 3-6-1 Shimosueyoshi, Tsurumi-ku, Yokohama, Kanagawa, 230-8765, Japan.
authors.forename: Masaharu
authors.initials: M
authors.lastname: Imaura
authors.affiliation: Department of Clinical Evaluation of Drug Efficacy, School of Pharmacy, Tokyo University of Pharmacy and Life Sciences, 1432-1 Horinouchi, Hachioji, Tokyo, 192-0392, Japan.
authors.forename: Haruko
authors.initials: H
authors.lastname: Yokoyama
authors.affiliation: Department of Pharmacy, Saiseikai Yokohamashi Tobu Hospital, 3-6-1 Shimosueyoshi, Tsurumi-ku, Yokohama, Kanagawa, 230-8765, Japan.
authors.forename: Yuji
authors.initials: Y
authors.lastname: Kohata
authors.affiliation: Department of Anesthesiology, Kyorin University Scool of Medicine, 6-20-2 Shinkawa, Mitaka-shi, Tokyo, 181-8611, Japan.
authors.forename: Riichiro
authors.initials: R
authors.lastname: Kanai
authors.affiliation: Department of Anesthesiology, Kyorin University Scool of Medicine, 6-20-2 Shinkawa, Mitaka-shi, Tokyo, 181-8611, Japan.
authors.forename: Tomoki
authors.initials: T
authors.lastname: Kohyama
authors.affiliation: Department of Anesthesiology, Toho University Omori Medical Center, 6-11-1 Omorinishi, Ota-ku, Tokyo, 143-8541, Japan.
authors.forename: Wataru
authors.initials: W
authors.lastname: Idemitsu
authors.affiliation: Department of Intensive Care, Saiseikai Yokohamashi Tobu Hospital, 3-6-1 Shimosueyoshi, Tsurumi-ku, Yokohama, Kanagawa, 230-8765, Japan.
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Maki
authors.affiliation: Department of Pharmacy, Saiseikai Yokohamashi Tobu Hospital, 3-6-1 Shimosueyoshi, Tsurumi-ku, Yokohama, Kanagawa, 230-8765, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Igarashi
authors.affiliation: Department of Intensive Care, Saiseikai Yokohamashi Tobu Hospital, 3-6-1 Shimosueyoshi, Tsurumi-ku, Yokohama, Kanagawa, 230-8765, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Takahashi
authors.affiliation: Department of Pharmacy, Saiseikai Yokohamashi Tobu Hospital, 3-6-1 Shimosueyoshi, Tsurumi-ku, Yokohama, Kanagawa, 230-8765, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kanno
authors.affiliation: Department of Clinical Evaluation of Drug Efficacy, School of Pharmacy, Tokyo University of Pharmacy and Life Sciences, 1432-1 Horinouchi, Hachioji, Tokyo, 192-0392, Japan. yamada@ps.toyaku.ac.jp.
authors.forename: Yasuhiko
authors.initials: Y
authors.lastname: Yamada
mesh_terms: D018806:APACHE; D000328:Adult; D000368:Aged; D001499:Bayes Theorem; D016638:Critical Illness; D005260:Female; D006207:Half-Life; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000187:drug effects; D008875:Middle Aged; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000097:blood* / Q000188:drug therapy*; D014640:Vancomycin / Q000008:administration & dosage* / Q000097:blood*
chemical_list: D014640:Vancomycin
keywords: APACHE II score; Dosage interval; Initial dose; Vancomycin therapy; Volume of distribution