title: The pharmacokinetics of vancomycin during the initial loading dose in patients with septic shock.
abstract: OBJECTIVE
  To characterize the pharmacokinetics (PK) of vancomycin in patients in the initial phase of septic shock.
  
  
  METHODS
  Twelve patients with septic shock received an intravenous infusion of vancomycin 30 mg/kg over 2 h. The vancomycin PK study was conducted during the first 12 h of the regimen. Serum vancomycin concentration-time data were analyzed using the standard model-independent analysis and the compartment model.
  
  
  RESULTS
  For the noncompartment analysis the mean values ± standard deviation (SD) of the estimated clearance and volume of distribution of vancomycin at steady state were 6.05±1.06 L/h and 78.73±21.78 L, respectively. For the compartmental analysis, the majority of vancomycin concentration-time profiles were best described by a two-compartment PK model. Thus, the two-compartmental first-order elimination model was used for the analysis. The mean ± SD of the total clearance (3.70±1.25 L/h) of vancomycin was higher than that obtained from patients without septic shock. In contrast, the volume of the central compartment (8.34±4.36 L) and volume of peripheral compartment (30.99±7.84 L) did not increase when compared with patients without septic shock.
  
  
  CONCLUSIONS
  The total clearance of vancomycin was increased in septic shock patients. However, the volume of the central compartment and peripheral compartment did not increase. Consequently, a loading dose of vancomycin should be considered in all patients with septic shock.
authors.affiliation: Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai.
authors.forename: Wasan
authors.initials: W
authors.lastname: Katip
authors.affiliation: Department of Medicine, Faculty of Medicine.
authors.forename: Sutep
authors.initials: S
authors.lastname: Jaruratanasirikul
authors.affiliation: Department of Clinical Pharmacy.
authors.forename: Sutthiporn
authors.initials: S
authors.lastname: Pattharachayakul
authors.affiliation: Department of Pharmaceutical Technology, Faculty of Pharmaceutical Sciences.
authors.forename: Wibul
authors.initials: W
authors.lastname: Wongpoowarak
authors.affiliation: Department of Toxicology, Faculty of Medicine, Prince of Songkla University, Songkla, Thailand.
authors.forename: Arnurai
authors.initials: A
authors.lastname: Jitsurong
authors.affiliation: Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai.
authors.forename: Aroonrut
authors.initials: A
authors.lastname: Lucksiri
keywords: MRSA; pharmacokinetics; septic shock patients; vancomycin