Vancomycin serum concentrations in pediatric oncologic/hematologic intensive care patients
Braz. j. infect. dis
;
16(4): 361-365, July-Aug. 2012. ilus, tab
Artigo
em Inglês
| LILACS
| ID: lil-645426
ABSTRACT
BACKGROUND:
Usual treatment regimens with vancomycin often fail to provide adequate serum levels in patients with severe infections.METHODS:
Retrospective analysis of vancomycin trough serum measurements. The following parameters were calculated by Bayesiananalysis:
vancomycin clearance, distribution volume, and peak estimated concentrations. The area under the concentration curve (AUC) (total daily dose/24 h clearance of vancomycin) was used to determine the effectiveness of treatment through the ratio of AUC/minimum inhibitory concentration (MIC) above 400, using MIC = 1 µg/mL, based on isolates of Staphylococci in cultures.RESULTS:
Sixty-one vancomycin trough measurements were analyzed in 31 patients. AUC/MIC > 400 was obtained in 34 out of 61 dosages (55.7%), but the mean vancomycin dose required to achieve these levels was 81 mg/kg/day. In cases where the usual doses were administered (40-60 mg/kg/day), AUC/MIC > 400 was obtained in nine out of 18 dosages (50%), in 13 patients. Trough serum concentrations above 15 mg/L presented a positive predictive value of 100% and a negative predictive value of 71% for AUC/MIC > 400.CONCLUSION:
Higher than usual vancomycin doses may be required to treat staphylococcal infections in children with oncologic/hematologic diseases. Since the best known predictor of efficacy is the AUC/MIC ratio, serum trough concentrations must be analyzed in conjunction with MICs of prevalent Staphylococci and pharmacokinetic tools such as Bayesian analysis.
Texto completo:
DisponíveL
Índice:
LILACS (Américas)
Assunto principal:
Infecções Estafilocócicas
/
Staphylococcus
/
Vancomicina
/
Antibacterianos
/
Neoplasias
Tipo de estudo:
Estudo observacional
/
Estudo prognóstico
/
Fatores de risco
Limite:
Adolescente
/
Criança
/
Criança, pré-escolar
/
Feminino
/
Humanos
/
Lactente
/
Masculino
Idioma:
Inglês
Revista:
Braz. j. infect. dis
Assunto da revista:
Doenças Transmissíveis
Ano de publicação:
2012
Tipo de documento:
Artigo
País de afiliação:
Brasil
Instituição/País de afiliação:
UNIFESP/BR
/
Universidade Federal de São Paulo/BR
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