title: Vancomycin Dosing Regimen by Monte Carlo Simulation in Patients on Intermittent High-Efficiency Hemodialysis (HEHD).
abstract: OBJECTIVE
  To evaluate the effective vancomycin dosing regimens by Monte Carlo simulation among patients on intermittent high-efficiency hemodialysis (HEHD).
  
  
  METHODS
  The present study was conducted on eight end-stage renal disease patients receiving HEHD. The patients received an initial dose of vancomycin 1 g followedby 500 mg immediately after HEHD session for a supplementation. Blood samplings were obtained to investigate vancomycin pharmacokinetic parameters. A Monte Carlo simulation was performed to determine the percentage of probability of target attainment (PTA) achieving AUC24/MIC ratio greater than or equal to 400 as the target of achievement of antimicrobial activity.
  
  
  RESULTS
  A loading dose (LD) of vancomycin of 20 mg per kilogram of dry weight (DW) with or without a supplementation had the optimum effectiveness for pathogens with MICs not greater than 0.5 mg/L. For pathogens with an MIC of 1.0 mg/L, the LD of 25 mg/kgDW followed by 20 or 25 mg/kgDW supplementation was achieved the target in some cases. Therefore, the LD of 30 mg/kgDW followed by 25 mg/kgDW or the LD of 35 mg/kgDW with 10, 20 or 25 mg/kgDW supplementation was required to achieve the target of antimicrobial activity.
  
  
  CONCLUSIONS
  From the present study, the lowest vancomycin dosing regimen that had the optimum effectiveness was a 35 mg/kgDW LD followed by 10 mg/kgDW supplementation. This regimen is recommended to treat pathogens with MICs not greater than 1.0 mg/L.
authors.forename: Daraporn
authors.initials: D
authors.lastname: Rungprai
authors.forename: Sutep
authors.initials: S
authors.lastname: Jaruratanasirikul
authors.forename: Wibul
authors.initials: W
authors.lastname: Wongpoowarak
authors.forename: Sutthiporn
authors.initials: S
authors.lastname: Pattharachayakul
authors.forename: Usanee
authors.initials: U
authors.lastname: Wanakamanee
authors.forename: Phongsak
authors.initials: P
authors.lastname: Dandecha
authors.forename: Arnurai
authors.initials: A
authors.lastname: Jitsurong
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D009010:Monte Carlo Method; D011446:Prospective Studies; D006435:Renal Dialysis / Q000379:methods*; D014640:Vancomycin / Q000008:administration & dosage*
chemical_list: D000900:Anti-Bacterial Agents; D014640:Vancomycin