title: Initial dosage regimen of vancomycin for septic shock patients: a pharmacokinetic study and Monte Carlo simulation.
abstract: OBJECTIVE
  To evaluate the pharmacokinetic parameters of vancomycin in septic shock patients and to determine the vancomycin dosage to achieve requisite pharmacokinetic/pharmacodynamic (PK/PD) target against methicillin resistant Staphylocccus aureus (MRSA) in patients with septic shock.
  
  
  METHODS
  Pharmacokinetic parameters of vancomycin in 12 septic shock patients were assessed. Then, the Monte Carlo simulation was performed to calculate the probabilities of target attainment (PTAs) to reach target AUC0-24/MIC of 400 and 450 mg.h/L.
  
  
  RESULTS
  The total clearance (CL) and the volume of the central compartment (Vc) of vancomycin was 3.34±1.39 L/h and 0.14±1.43 L/kg, respectively. For Staphylococcalspp. with low MICs of 0.125 and 0.5 mg/L, the administration of vancomycin 30 mg/kg as the loading dose, followed by the maintenance dose of 20 mg/kg every six, eight, 12, and 24 hours achieved >90% PTAs to reach target AUC0-24/MlC: For pathogens with MIC of 1, and 1.5 mg/L, the vancomycin maintenance dose of 20 mg/kg every six, eight, and 12 hours and every six and eight hours respectively to achieve >90% PTA.
  
  
  CONCLUSIONS
  High dose ofvancomycin is required to achieve PK/PD target for treatment of MRSA septic shock, especially if MRSA MIC is higher than 1 mg/L.
authors: Wasan
authors: W
authors: Katip Bpharm
authors: Sutep
authors: S
authors: Jaruratanasirikul
authors: Sutthiporn
authors: S
authors: Pattharachayakul
authors: Wibul
authors: W
authors: Wongpoowarak
authors: Arnurai
authors: A
authors: Jitsurong
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000493:pharmacokinetics*; D003198:Computer Simulation; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D006785:Hospitals, University; D006801:Humans; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000187:drug effects*; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D009010:Monte Carlo Method; D012772:Shock, Septic / Q000188:drug therapy*; D013203:Staphylococcal Infections / Q000188:drug therapy*; D013785:Thailand; D014640:Vancomycin / Q000008:administration & dosage* / Q000493:pharmacokinetics*; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D014640:Vancomycin