Vancomycin administration patterns in critically ill patients

Abstract

Vancomycin is an antimicrobial used in intensive care units for the treatment of Gram-positive cocci infections. The main PK/PD parameter, predictor of vancomycin activity, is the AUC/MIC greater than 400; this is reached with plasma drug concentrations of 15 to 20 mg/l in the context of a patient with normal renal function. In critically ill patients, there are changes in the pharmacokinetic patterns that lead to sub-therapeutic doses of the antibiotic and a requirement for monitoring the vancomycin levels. There was reviewed literature on this field to determine the best vancomycin administration regimen in critically ill patients, and to establish the basic prescription parameters in this population. It was found that continuous infusion of vancomycin was associated with better results since it reached the necessary plasma concentration levels earlier. The loading dose was in the range of 15 to 30 mg/kg and the maintenance dose averaged between 30 to 40 mg/kg per day.

The target plasma concentration of vancomycin used in most of the studies ranged between 15 and 20 mg/l. In conclusion, the continuous administration of vancomycin shows better results compared to intermittent administration. High doses in loading and maintenance are the most recommended since these do not increase the risk of nephrotoxicity. Finally, PK/PD strategies are useful for adjusting the dose of critically ill patients.