Pharmacokinetic and pharmacodynamic approach in adult critically-ill patients treated with standard dose of vancomycin for MRSA infection

Abstract

© 2018, Medical Association of Thailand. All rights reserved. Background: The achievement of vancomycin’s pharmacokinetic/pharmacodynamic [PK/PD] index, i.e., AUC24/MIC 400 mg-hour/L or more, is highly determined by pharmacokinetic parameters of different groups of patients. Objective: To investigate the possibility of standard dose of vancomycin to achieve AUC24/MIC of 400 mg-hour/L or more in critically-ill adult patients. Materials and Methods: The literature search was conducted in PubMed, Cochrane, and Trip Database from database inception until August 2012 by using MeSH term and combination of several keywords. Studies included in the present review should present population pharmacokinetic equation model. Further analysis would consider mean, minimum, and maximum values of covariates that influenced the pharmacokinetic equation models. The maximum MIC was chosen to be 2 mg/L according to susceptibility breakpoint of Staphylococcus aureus to vancomycin. Results: Four studies were included in the present study. The range of volume distribution, clearance, AUC24, and MIC coverage calculated by using mean value of influential covariates of pharmacokinetic equation model were 59.86 to 149.05 L, 3.03 to 4.15 L/hour, 481.46 to 661.09 mg-hour/L, and 1.20 to 1.65 mg/L, respectively. The minimum and maximum values of influential covariates gave the following results, 36.90 to 306.27 L, 0.18 to 13.22 L/hour, 151.34 to 10,917.03 mg-hour/L, and 0.38 to 27.29 mg/L, respectively. Conclusion: Not all critically-ill patients infected with vancomycin-susceptible MRSA were effectively treated by standard dose of vancomycin. Drug concentration monitoring and MRSA’s MIC testing are needed to be regularly conducted to ensure the effectiveness of vancomycin treatment.