Vancomycin clearance during continuous venovenous haemofiltration in critically ill patients

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• 作者：Weerachai Chaijamorn^a ; ^{zernpharm@yahoo.com"" rel=""nofollow} ; Arnurai Jitsurong^b ; Kamonthip Wiwattanawongsa^c ; Usanee Wanakamanee^c ; Phongsak Dandecha^d
• 关键词：Vancomycin ; Continuous venovenous haemofiltration (CVVH) ; Pharmacokinetics ; Critically ill patients ; Clearance
• 刊名：International Journal of Antimicrobial Agents
• 出版年：2011
• 出版时间：August 2011
• 年：2011
• 卷：38
• 期：2
• 页码：152-156
• 全文大小：241 K

文摘

The objective of this study was to determine the pharmacokinetics and dosing recommendations of vancomycin in critically ill patients receiving continuous venovenous haemofiltration (CVVH). A prospective study was conducted in the Intensive Care Unit of a university hospital. Seven patients receiving CVVH with a triacetate hollow-fibre dialyser were enrolled. CVVH was performed in pre-dilution mode with a blood flow rate of 200–250 mL/min and an ultrafiltrate flow rate of 800–1200 mL/h. To determine vancomycin pharmacokinetics, serum and ultrafiltrate were collected over 12 h after a 2-h infusion of 1000 mg vancomycin. The mean (± standard deviation) sieving coefficient of vancomycin was 0.71 ± 0.13, which is consistent with previously reported values. Clearance of vancomycin by CVVH (0.73 ± 0.21 L/h or 12.11 ± 3.50 mL/min) constituted 49.4 ± 20.8 % of total vancomycin clearance (1.59 ± 0.47 L/h) and was consistent with previously reported clearances. Approximately one-fifth of the vancomycin dose was removed during the 12-h CVVH (213.9 ± 104.0 mg). The volume of distribution was 24.69 ± 11.00 L, which is smaller than previously reported. The elimination rate constant and terminal half-life were 0.08 ± 0.05 h⁻¹ and 12.02 ± 7.00 h, respectively. In conclusion, elimination of vancomycin by CVVH contributed to ca. 50 % of the total elimination in critically ill patients. The maintenance dose of vancomycin, calculated from parameters from patients in this study, would be 500–750 mg every 12 h to provide a steady-state trough concentration of 15–20 mg/L. Owing to alterations in clinical conditions, serum vancomycin concentrations must be closely monitored in critically ill patients.