title: Pharmacokinetics of Vancomycin in Elderly Patients Aged over 80 Years.
abstract: Since the 1950s, vancomycin has remained a reference treatment for severe infections caused by Gram-positive bacteria, including methicillin-resistant Staphylococcus aureus Vancomycin is a nephrotoxic and ototoxic drug mainly eliminated through the kidneys. It has a large interindividual pharmacokinetic variability, which justifies monitoring its plasma concentrations in patients. This is especially important in patients aged over 80 years, who frequently have renal impairment. However, the pharmacokinetics of vancomycin in this population is very poorly described in the literature. The objective of this work was to propose a model able to predict the pharmacokinetics of vancomycin in very elderly people. First, a population pharmacokinetic model was carried out using the algorithm NPAG (nonparametric adaptive grid) on a database of 70 hospitalized patients aged over 80 years and treated with vancomycin. An external validation then was performed on 41 patients, and the predictive capabilities of the model were assessed. The model had two compartments and six parameters. Body weight and creatinine clearance significantly influenced vancomycin volume of distribution and body clearance, respectively. The means (± standard deviations) of vancomycin volume of distribution and clearance were 36.3 ± 15.2 liter and 2.0 ± 0.9 liter/h, respectively. In the validation group, the bias and precision were -0.75 mg/liter and 8.76 mg/liter for population predictions and -0.39 mg/liter and 2.68 mg/liter for individual predictions. In conclusion, a pharmacokinetic model of vancomycin in a very elderly population has been created and validated for predicting plasma concentrations of vancomycin.
authors.affiliation: Hospices Civils de Lyon, Groupement Hospitalier de Gériatrie, Hôpital Antoine Charial, Service Pharmaceutique, Francheville, France UMR CNRS 5558, Laboratoire de Biométrie et Biologie Evolutive, Université Lyon 1, Lyon, France ISPB, Faculté de Pharmacie, Université Lyon 1, Lyon, France laurent.bourguignon@chu-lyon.fr.
authors.forename: Laurent
authors.initials: L
authors.lastname: Bourguignon
authors.affiliation: Hospices Civils de Lyon, Groupement Hospitalier de Gériatrie, Hôpital Antoine Charial, Service Pharmaceutique, Francheville, France UMR CNRS 5558, Laboratoire de Biométrie et Biologie Evolutive, Université Lyon 1, Lyon, France.
authors.forename: Yoann
authors.initials: Y
authors.lastname: Cazaubon
authors.affiliation: Hospices Civils de Lyon, Groupement Hospitalier de Gériatrie, Hôpital Antoine Charial, Service Pharmaceutique, Francheville, France.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Debeurme
authors.affiliation: Hospices Civils de Lyon, Groupement Hospitalier de Gériatrie, Hôpital Antoine Charial, Service Pharmaceutique, Francheville, France.
authors.forename: Constance
authors.initials: C
authors.lastname: Loue
authors.affiliation: Hospices Civils de Lyon, Groupement Hospitalier de Gériatrie, Hôpital Antoine Charial, Service Pharmaceutique, Francheville, France.
authors.forename: Michel
authors.initials: M
authors.lastname: Ducher
authors.affiliation: Hospices Civils de Lyon, Groupement Hospitalier de Gériatrie, Hôpital Antoine Charial, Service Pharmaceutique, Francheville, France UMR CNRS 5558, Laboratoire de Biométrie et Biologie Evolutive, Université Lyon 1, Lyon, France ISPB, Faculté de Pharmacie, Université Lyon 1, Lyon, France.
authors.forename: Sylvain
authors.initials: S
authors.lastname: Goutelle
mesh_terms: D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000493:pharmacokinetics* / Q000494:pharmacology*; D001835:Body Weight / Q000187:drug effects; D005260:Female; D006801:Humans; D008297:Male; D013211:Staphylococcus aureus / Q000187:drug effects; D014640:Vancomycin / Q000493:pharmacokinetics* / Q000494:pharmacology*
chemical_list: D000900:Anti-Bacterial Agents; D014640:Vancomycin