title: A specially tailored vancomycin continuous infusion regimen for renally impaired critically ill patients.
abstract: BACKGROUND
  Vancomycin remains the gold standard for treatment of methicillin-resistant Staphylococcus aureus. Specially designed continuous infusion of vancomycin leads to better therapy.
  
  
  METHODS
  A total of 40 critically ill patients who suffered from pneumonia susceptible to vancomycin, had serum creatinine >1.4 mg%, and oliguria <0.5 mL/kg/h for 6 h were included in the study with respiratory culture sensitivity to vancomycin ≤2 mg/L. Patients' clinical, microbiological, and biological data were obtained by retrospective analysis of the corresponding medical files before and after vancomycin treatment. Patients with serum creatinine level ≥4 mg% and patients who received renal replacement therapy during the treatment period were excluded. The patients were divided into two groups-group 1 (intermittent dosing) and group 2 (continuous infusion) based on the following formula: rate of vancomycin continuous infusion (g/day) = [0.0205 creatinine clearance (mL/min) + 3.47] × [target vancomycin concentration at steady state (µg/mL)] × (24/1000). Trough vancomycin serum levels were also assessed using high-performance liquid chromatographic technique. Patients' outcomes such as clinical improvement, adverse events, and 15-day mortality were reported.
  
  
  RESULTS
  Group 2 showed significant reduction in blood urea nitrogen, creatinine serum levels, white blood cells, partial carbon dioxide pressure, body temperature, and Sequential Organ Failure Assessment score, while significant increase in partial oxygen pressure and saturated oxygen was also observed. A significantly shorter duration of treatment with a comparable vancomycin serum levels was also reported with group 2.
  
  
  CONCLUSIONS
  After treatment, comparison in patients' criteria supports the superiority of using continuous infusion of vancomycin according to this equation in renally impaired patients.
authors.affiliation: Critical Care Medicine Department, Cairo University Hospitals, Cairo, Egypt.
authors.forename: Eman Mohamed Bahgat
authors.initials: EM
authors.lastname: Eldemiry
authors.affiliation: Faculty of Pharmacy, Cairo University, Cairo, Egypt.
authors.forename: Nirmeen A
authors.initials: NA
authors.lastname: Sabry
authors.affiliation: Faculty of Pharmacy, Cairo University, Cairo, Egypt.
authors.forename: Maggie M
authors.initials: MM
authors.lastname: Abbassi
authors.affiliation: Faculty of Medicine, Beni Suef University, Beni Suef, Egypt.
authors.forename: Sanaa S
authors.initials: SS
authors.lastname: Abdel Shafy
authors.affiliation: Critical Care Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt.
authors.forename: Mohamed S
authors.initials: MS
authors.lastname: Mokhtar
authors.affiliation: Faculty of Pharmacy, Cairo University, Cairo, Egypt.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Abdel Bary
keywords: Vancomycin; continuous infusion; critically ill; high-performance liquid chromatographic; therapeutic drug monitoring