Event Title
Medical Use Evaluation of Vancomycin Dosing to Create Hospital-Specific Vancomycin Nomogram
Location
Georgia
Start Date
16-5-2017 1:00 PM
Description
Various methods of estimating vancomycin pharmacokinetic parameters have been developed to calculate appropriate dosing regimens. This study compares four different pharmacokinetic models to determine which model best fits a specific hospital patient population. The primary outcome is to assess the appropriateness of vancomycin dosing and create a hospital-specific vancomycin nomogram.
This is a single-center retrospective study conducted at a 202 bed community general medical and surgical institution. Data for patients receiving vancomycin from November 1, 2014 through May 1, 2016 were included in the study. Predicted vancomycin levels were obtained using estimated eliminations rates, dosing intervals and maintenance doses. Calculated and observed trough levels were compared to determine the best pharmacokinetic model. Once the most appropriate pharmacokinetic model was identified, it was then used to develop vancomycin dosing nomograms for two goal trough ranges: 10-15 mg/L and 15-20 mg/L.
A total of 185 patients were enrolled in the study with 45 achieving targeted trough levels, 124 being subtherapeutic and 16 being supratherapeutic at steady state. The most common indications for vancomycin use included pneumonia, cellulitis, sepsis, UTI and empiric therapy. Based upon the calculated values, it was determined that the Creighton method had the smallest RMSE and MAE (5.23, 3.25) and was the second least biased among the other four methods. By using the Creighton method, two nomograms were developed, one for a targeted vancomycin trough concentration at 10-15 mg/L and the other for a target of 15-20 mg/L.
A vancomycin nomogram is an alternative and efficient way of dosing compared to conventional methods. Furthermore, implementing an institution specific nomogram can lead to a successful clinical response with decreased adverse effects.
Embargo Period
6-26-2017
Medical Use Evaluation of Vancomycin Dosing to Create Hospital-Specific Vancomycin Nomogram
Georgia
Various methods of estimating vancomycin pharmacokinetic parameters have been developed to calculate appropriate dosing regimens. This study compares four different pharmacokinetic models to determine which model best fits a specific hospital patient population. The primary outcome is to assess the appropriateness of vancomycin dosing and create a hospital-specific vancomycin nomogram.
This is a single-center retrospective study conducted at a 202 bed community general medical and surgical institution. Data for patients receiving vancomycin from November 1, 2014 through May 1, 2016 were included in the study. Predicted vancomycin levels were obtained using estimated eliminations rates, dosing intervals and maintenance doses. Calculated and observed trough levels were compared to determine the best pharmacokinetic model. Once the most appropriate pharmacokinetic model was identified, it was then used to develop vancomycin dosing nomograms for two goal trough ranges: 10-15 mg/L and 15-20 mg/L.
A total of 185 patients were enrolled in the study with 45 achieving targeted trough levels, 124 being subtherapeutic and 16 being supratherapeutic at steady state. The most common indications for vancomycin use included pneumonia, cellulitis, sepsis, UTI and empiric therapy. Based upon the calculated values, it was determined that the Creighton method had the smallest RMSE and MAE (5.23, 3.25) and was the second least biased among the other four methods. By using the Creighton method, two nomograms were developed, one for a targeted vancomycin trough concentration at 10-15 mg/L and the other for a target of 15-20 mg/L.
A vancomycin nomogram is an alternative and efficient way of dosing compared to conventional methods. Furthermore, implementing an institution specific nomogram can lead to a successful clinical response with decreased adverse effects.