Publication: The use of monte carlo simulation to predict vancomycin dosage for methicillin-resistant staphylococcus aureus in Thai patients of various ages and with varying degrees of renal function
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Issued Date
2017-08-01
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ISSN
1875855X
19057415
19057415
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2-s2.0-85048543427
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Mahidol University
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SCOPUS
Bibliographic Citation
Asian Biomedicine. Vol.11, No.4 (2017), 379-385
Suggested Citation
Krairerk Pitaksontayothin, Wichai Santimaleeworagun, Manat Pongchaidecha, Jantana Houngsaitong, Panuwit Srisena The use of monte carlo simulation to predict vancomycin dosage for methicillin-resistant staphylococcus aureus in Thai patients of various ages and with varying degrees of renal function. Asian Biomedicine. Vol.11, No.4 (2017), 379-385. doi:10.1515/abm-2018-0011 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/41827
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Title
The use of monte carlo simulation to predict vancomycin dosage for methicillin-resistant staphylococcus aureus in Thai patients of various ages and with varying degrees of renal function
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Abstract
© 2017 Krairerk Pitaksontayothin, Wichai Santimaleeworagun, Manat Pongchaidecha, Jantana Houngsaitong, Panuwit Srisena This Work is licensed under Creative Common License Background: To our knowledge, no study reported so far has investigated appropriate vancomycin dosing, which is important for treatment of methicillin-resistant Staphylococcus aureus (MRSA) infection in Thai patients of various ages and with varying degrees of renal function. Objectives: To predict vancomycin dosing for MRSA in Thai patients of various ages and with varying degrees of renal functions. Methods: Monte Carlo simulation and minimal inhibitory concentration (MIC) distribution of MRSA from a hospital in Thailand were used to predict the area under the curve in 24 h/MIC >400 and trough concentration (Ctrough) <20 mg/L of 9 vancomycin dosage regimens for Thai patients stratified by age and renal function. Results: Vancomycin dosing at least 2.5 g per day can attain cumulative fraction of response (CFR) of =90% in every age group. Vancomycin dosage achieving CFR of =90% for simulated patients with creatinine clearance (CLcr) was calculated using the Cockcroft-Gault equation. Appropriate vancomycin doses for Thai patients infected with MRSA with CLcrof <40, 40-60, >60-80, and >80 mL/min were 1.5 g every 24 h, 1.25 g every 12 h, 1 g every 8 h, and 1.75 g every 12 h, respectively. However, more than a half of patients simulated using these regimens have a vancomycin Ctroughof >20 mg/L. Conclusions: Although vancomycin doses attaining a CFR of =90% can treat MRSA infection effectively, the regimens may cause kidney injury. The regimens have a probability of target attainment of 100%, and most patients can attain Ctroughof <20 mg/L.