Evaluation of initial dosing regimens of vancomycin used in the treatment of infections in patients into a trauma intensive care unit
DOI:
https://doi.org/10.30968/rbfhss.2022.134.0845Abstract
Objective: To verify the exposure to vancomycin in patients admitted to the ICU of trauma from a regional hospital compared to consensos exposure ranges therapy. Methods: Retrospective cross-sectional study, with data collection from electronic medical records of the patients using Vancomycin admitted to the trauma ICU at Hospital Pronto Socorro de Porto Alegre (RS) from January 2022 to May 2022. Results: We evaluated 28 patients who met the inclusion criteria in the study, of these, thirteen (46.42%) presented subtherapeutic trough concentrations of vancomycin, six (21.42%) had therapeutic concentrations and nine (32.14%) had supratherapeutic concentrations. The highest levels of vancomycin occurred between the 2nd and 4th day of treatment. Among the applied attack doses, seven (41.17%) received doses within the recommended range (average of 28.80 mg/kg) and fifteen (53.6%) the initial dose was within the range recommended by international guidelines. Less than 25% of subjects had therapeutic exposure to vancomycin. Conclusion: Therapeutic drug monitoring for vancomycin associated with a pharmacokinetic program that estimates dose adjustments favors the optimization of the therapy, increases the efficiency and benefits of the treatment.
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References
Heckler AM, Hahn SR. Implementation of a vancomycin therapeutic monitoring protocol in adults. Revista de Epidemiologia e Controle de Infecção 2020; 10: 3. doi: 10.17058/jeic.v10i3.14582.
Lima FLO, Almeida PC, de Oliveira GL. Enterococcus spp. Resistentes à vancomicina e a sua disseminação em infecções no ambiente hospitalar. Research, Society and Development 2020; 9:8. doi: 10.33448/rsd-v9i8.6404.
Obara VY, Zacas CP, Carrilho CMDM, et al. Esquema posológico atualmente utilizado para vancomicina falha em obter níveis terapêuticos em 40% dos pacientes internados em unidade de terapia intensiva. Revista brasileira de terapia intensiva 2016; 28:380-386. doi: 10.5935/0103-507X.20160071.
Almeida R. Vancomicina: avaliação do uso em pacientes internados na unidade de terapia intensiva [dissertação], 2011. Faculdade de Medicina, Rio Grande do Sul, Porto Alegre, 2011. Disponível em: https://www.lume.ufrgs.br/handle/10183/30995. Acessado em: 15 de maio 2022.
Terra R, da Silva RS. Vancomicina-um antimicrobiano de importância nosocominal. Brazilian Journal of Surgery and Clinical Research 2017; 19:3 76-80.
Vancomicina, cloridrato de vancomicina. São Paulo: Blau Farmacêutica S.A., 2017. Bula de remédio. Available in: https://www.blau.com.br/storage/app/media/Bulas%20Novas%20%2029.08.17/bulapacienteclor-de-vancomicina.pdf . Accessed on: 20th Mach 2022.
Medeiros AC, Filho AM. Resposta metabólica ao trauma. Journal of Surgical and Clinical Research 2017; 8:1 56-76. doi: 10.20398/jscr.v8i1.13036.
Medellín-Garibay SE, Ortiz-Martín B, Rueda-Nahharo A, et al. Pharmacokinetics of vancomycin and dosing recommendations for trauma patients. Journal of Antimicrobial Chemothery 2016; 71:2 471–479, 2016. DOI: 10.1093/jac/dkv372.
Villanueva RD, Tolledo O, Neely S, et al. Vancomycin dosing in critically ill trauma patients: The VANCTIC Study. Journal of Trauma and Acute Care Surgery 2019; 87:5. doi: 10.1097/TA.0000000000002492.
BRASIL. RESOLUÇÃO nº 675, de 31 de outubro de 2019. “Regulamenta as atribuições do farmacêutico clínico em unidades de terapia intensiva, e dá outras providências.” Available in https://www.in.gov.br/web/dou/-/resolucao-n--675-de-31-de-outubro-de-2019-228899312. Accessed on: 05th Apr 2022.
Dombroski V, da Silva MG, Silveira ME. Monitoramento terapêutico de vancomicina em uma unidade de terapia intensiva. Revista médica da UFPR 2015; 2:2. doi: 10.5380/rmu.v2i2.42233.
Rybak MJ, Le J, Lodise TP, et al. Therapeutic Monitoring of Vancomycin for Serious Methicillin-Resistant Staphylococcus aureus Infections: A Revised Consensus Guideline and Review of the American Society of Health System Pharmacists, the Infectious Diseases Society of America, the Pediatric Infectious Diseases Society, and the Society of Infectious Diseases Pharmacists. Journal of the Pediatric Infectious Diseases Society 2020. 9:3. doi: 10.1093/ajhp/zxaa036.
Rybak MJ, Lomaestro BM, Rotschafer JC, et al. Vancomycin therapeutic guidelines: a summary of consensus recommendations from the infectious diseases Society of America, the American Society of Health-System Pharmacists, and the Society of Infectious Diseases. Clinical Infectious Diseases 2009; 49:3. doi: 10.1086/600877.
Eid KZ. Impacto do nível sérico da vancomicina no prognóstico de pacientes sépticos admitidos em unidade de terapia intensiva, 2018. Faculdade de Medicina de Botucatu, São Paulo, 2018. Available in: https://repositorio.unesp.br/handle/11449/152994. Accessed on: 22nd Mach 2022.
Barbosa FC, Ferreira TC, Filho NS. Avaliação do Desempenho das Equações de Cockcroft-Gault e do Estudo “Modification of Diet in Renal Disease” em Transplantados Renais. Jornal Brasileiro de Nefrologia 2008; 30:3. 2008.
Kirkpatrick CMJ, Duffull SB, Begg EJ. Pharmacokinetics of gentamicin in 957 patients with varying renal function dosed once daily. British Journal of Clinical Pharmacology 1997; 47:637–643. doi: 10.1046/j.1365-2125.1999.00938.x.
Buelga DS, Gatta MDMF, Herrera EV, et al. Population Pharmacokinetic Analysis of Vancomycin in Patients with Hematological Malignancies. Antimicrobial Agents and Chemotherapy 2005; 49:12. doi: 10.1128/AAC.49.12.4934-4941.2005.
SA Health - Government of South Australia. Vancomycin Dosing and Monitoring in Adults Clinical Guideline. Version 1.1. Available in: https://www.sahealth.sa.gov.au/wps/wcm/connect/34ea68004f51be35ae5aeedd8959a390/Vancomycin_dosing_monitoring_guideline_v1.1. Accessed in: 30th May 2022.
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