title: An Approach to Optimise Therapeutic Vancomycin Dosage in a Haemodialysis Population.
abstract: Haemodialysis patients are at risk of gram-positive bacteraemia and commonly require intravenous vancomycin. Intravenously administered vancomycin is primarily excreted by the kidney and exhibits complex pharmacokinetics in haemodialysis patients; achieving therapeutic levels can be challenging. An audit in our unit showed current practises of vancomycin administration resulted in a high proportion of sub-therapeutic levels. A new protocol was developed with fixed weight-based loading and subsequent dosing guided by pre-dialysis levels, target levels were 10-20mg/L. Its effectiveness was prospectively evaluated between 24th September 2012, and 8th February 2013. During this period 25 patients commenced vancomycin, 15 were included. In total, 112 vancomycin levels were taken, 94 (84%) were therapeutic, this was a significant improvement compared to previous practise (odds ratio 5.4, CI 3.1-9.4, p<0.0001). In conclusion, our study shows this protocol can consistently and reliably achieve therapeutic vancomycin levels.
authors.affiliation: Trinity Health Kidney Centre, AMNCH, Tallaght, Dublin 24.
authors.forename: H
authors.initials: H
authors.lastname: Gunning
authors.affiliation: Trinity Health Kidney Centre, AMNCH, Tallaght, Dublin 24.
authors.forename: G
authors.initials: G
authors.lastname: Taylor
authors.affiliation: Trinity Health Kidney Centre, AMNCH, Tallaght, Dublin 24.
authors.forename: A
authors.initials: A
authors.lastname: Smyth
authors.affiliation: Trinity Health Kidney Centre, AMNCH, Tallaght, Dublin 24.
authors.forename: G
authors.initials: G
authors.lastname: Mellotte
authors.affiliation: Trinity Health Kidney Centre, AMNCH, Tallaght, Dublin 24.
authors.forename: J
authors.initials: J
authors.lastname: Fennell
authors.affiliation: Trinity Health Kidney Centre, AMNCH, Tallaght, Dublin 24.
authors.forename: P
authors.initials: P
authors.lastname: Murphy
authors.affiliation: Trinity Health Kidney Centre, AMNCH, Tallaght, Dublin 24.
authors.forename: P
authors.initials: P
authors.lastname: Lavin
authors.affiliation: Trinity Health Kidney Centre, AMNCH, Tallaght, Dublin 24.
authors.forename: C
authors.initials: C
authors.lastname: Wall
mesh_terms: D061605:Administration, Intravenous; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000493:pharmacokinetics; D016470:Bacteremia / Q000188:drug therapy* / Q000378:metabolism / Q000382:microbiology; D054796:Drug Dosage Calculations; D016908:Gram-Positive Bacterial Infections / Q000188:drug therapy* / Q000378:metabolism / Q000382:microbiology; D006801:Humans; D011446:Prospective Studies; D006435:Renal Dialysis / Q000009:adverse effects*; D014640:Vancomycin / Q000008:administration & dosage* / Q000493:pharmacokinetics
chemical_list: D000900:Anti-Bacterial Agents; D014640:Vancomycin