Vancomycin therapeutic drug monitoring and population pharmacokinetic models in special patient subpopulations

Joaquim F Monteiro, Siomara R Hahn, Jorge Gonçalves, Paula Fresco, Joaquim F Monteiro, Siomara R Hahn, Jorge Gonçalves, Paula Fresco

Abstract

Vancomycin is a fundamental antibiotic in the management of severe Gram-positive infections. Inappropriate vancomycin dosing is associated with therapeutic failure, bacterial resistance and toxicity. Therapeutic drug monitoring (TDM) is acknowledged as an important part of the vancomycin therapy management, at least in specific patient subpopulations, but implementation in clinical practice has been difficult because there are no consensus and agglutinator documents. The aims of the present work are to present an overview of the current knowledge on vancomycin TDM and population pharmacokinetic (PPK) models relevant to specific patient subpopulations. Based on three published international guidelines (American, Japanese and Chinese) on vancomycin TDM and a bibliographic review on available PPK models for vancomycin in distinct subpopulations, an analysis of evidence was carried out and the current knowledge on this topic was summarized. The results of this work can be useful to redirect research efforts to address the detected knowledge gaps. Currently, TDM of vancomycin presents a moderate level of evidence and practical recommendations with great robustness in neonates, pediatric and patients with renal impairment. However, it is important to investigate in other subpopulations known to present altered vancomycin pharmacokinetics (eg neurosurgical, oncological and cystic fibrosis patients), where evidence is still unsufficient.

Keywords: pharmacokinetics; special subpopulations; therapeutic drug monitoring; vancomycin.

© 2018 The Authors. Pharmacology Research & Perspectives published by John Wiley & Sons Ltd, British Pharmacological Society and American Society for Pharmacology and Experimental Therapeutics.

Figures

Figure 1
Figure 1
Population pharmacokinetic model review (PPK Model review) flow chart

References

    1. Ye ZK, Li C, Zhai SD. Guidelines for therapeutic drug monitoring of vancomycin: a systematic review. PLoS ONE. 2014;9:e99044.
    1. Rybak M, Lomaestro B, Rotschafer JC, et al. Therapeutic monitoring of vancomycin in adult patients: a consensus review of the American Society of Health‐System Pharmacists, the Infectious Diseases Society of America, and the Society of Infectious Diseases Pharmacists. AJHP. 2009;66:82‐98.
    1. Matsumoto K, Takesue Y, Ohmagari N, et al. Practice guidelines for therapeutic drug monitoring of vancomycin: a consensus review of the Japanese Society of Chemotherapy and the Japanese Society of Therapeutic Drug Monitoring. J. Infect. Chemother. 2013;19:365‐380.
    1. Ye ZK, Chen YL, Chen K, et al. Therapeutic drug monitoring of vancomycin: a guideline of the Division of Therapeutic Drug Monitoring, Chinese Pharmacological Society. J. Antimicrob. Chemother. 2016;71:3020‐3025.
    1. Guyatt GH, Oxman AD, Vist GE, et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ. 2008;336:924‐926.
    1. Ye ZK, Tang HL, Zhai SD. Benefits of therapeutic drug monitoring of vancomycin: a systematic review and meta‐analysis. PLoS ONE. 2013;8:e77169.
    1. Cardile AP, Tan C, Lustik MB, et al. Optimization of time to initial vancomycin target trough improves clinical outcomes. SpringerPlus. 2015;4:364.
    1. Charmillon A, Novy E, Agrinier N, et al. The ANTIBIOPERF study: a nationwide cross‐sectional survey about practices for beta‐lactam administration and therapeutic drug monitoring among critically ill patients in France. Clin. Microbiol. Infect. 2016;22:625‐631.
    1. Roustit M, Francois P, Sellier E, et al. Evaluation of glycopeptide prescription and therapeutic drug monitoring at a university hospital. Scand. J. Infect. Dis. 2010;42:177‐184.
    1. Swartling M, Gupta R, Dudas V, Guglielmo BJ. Short term impact of guidelines on vancomycin dosing and therapeutic drug monitoring. Int. J. Clin. Pharm. 2012;34:282‐285.
    1. Crowley RK, Fitzpatrick F, Solanki D, FitzGerald S, Humphreys H, Smyth EG. Vancomycin administration: the impact of multidisciplinary interventions. J. Clin. Pathol. 2007;60:1155‐1159.
    1. Thalakada R, Legal M, Lau TT, Luey T, Batterink J, Ensom MH. Development and validation of a novel vancomycin dosing nomogram for achieving high‐target trough levels at 2 canadian teaching hospitals. Can. J. Hosp. Pharm. 2012;65:180‐187.
    1. Nakayama H, Echizen H, Tanaka M, Sato M, Orii T. Reduced vancomycin clearance despite unchanged creatinine clearance in patients treated with vancomycin for longer than 4 weeks. Ther. Drug Monit. 2008;30:103‐107.
    1. Avent ML, Vaska VL, Rogers BA, et al. Vancomycin therapeutics and monitoring: a contemporary approach. Intern. Med. J. 2013;43:110‐119.
    1. Hiraki Y, Onga T, Mizoguchi A, Tsuji Y. Investigation of the prediction accuracy of vancomycin concentrations determined by patient‐specific parameters as estimated by Bayesian analysis. J. Clin. Pharm. Ther. 2010;35:527‐532.
    1. Deng C, Liu T, Zhou T, et al. Initial dosage regimens of vancomycin for Chinese adult patients based on population pharmacokinetic analysis. Int. J. Clin. Pharmacol. Ther. 2013;51:407‐415.
    1. Yamamoto M, Kuzuya T, Baba H, Yamada K, Nabeshima T. Population pharmacokinetic analysis of vancomycin in patients with gram‐positive infections and the influence of infectious disease type. J. Clin. Pharm. Ther. 2009;34:473‐483.
    1. Thomson AH, Staatz CE, Tobin CM, Gall M, Lovering AM. Development and evaluation of vancomycin dosage guidelines designed to achieve new target concentrations. J. Antimicrob. Chemother. 2009;63:1050‐1057.
    1. Bakke V, Sporsem H, Von der Lippe E, et al. Vancomycin levels are frequently subtherapeutic in critically ill patients: a prospective observational study. Acta Anaesthesiol. Scand. 2017;61:627‐635.
    1. Tabah A, De Waele J, Lipman J, et al. The ADMIN‐ICU survey: a survey on antimicrobial dosing and monitoring in ICUs. J. Antimicrob. Chemother. 2015;70:2671‐2677.
    1. Jeurissen A, Sluyts I, Rutsaert R. A higher dose of vancomycin in continuous infusion is needed in critically ill patients. Int. J. Antimicrob. Agents. 2011;37:75‐77.
    1. Roberts JA, Lipman J, Blot S, Rello J. Better outcomes through continuous infusion of time‐dependent antibiotics to critically ill patients? Curr. Opin. Crit. Care. 2008;14:390‐396.
    1. Hirai K, Ishii H, Shimoshikiryo T, et al. Augmented renal clearance in patients with febrile neutropenia is associated with increased risk for subtherapeutic concentrations of vancomycin. Ther. Drug Monit. 2016;38:706‐710.
    1. Oami T, Hattori N, Matsumura Y, et al. The effects of fasting and massive diarrhea on absorption of enteral vancomycin in critically ill patients: a retrospective observational study. Front. Med. 2017;4:70.
    1. Hahn A, Frenck RW Jr, Allen‐Staat M, Zou Y, Vinks AA. Evaluation of target attainment of vancomycin area under the curve in children with methicillin‐resistant Staphylococcus aureus bacteremia. Ther. Drug Monit. 2015;37:619‐625.
    1. Buyle FM, Decruyenaere J, De Waele J, et al. A survey of beta‐lactam antibiotics and vancomycin dosing strategies in intensive care units and general wards in Belgian hospitals. Eur. J. Clin. Microbiol. Infect. Dis. 2013;32:763‐768.
    1. Tafelski S, Nachtigall I, Troeger U, et al. Observational clinical study on the effects of different dosing regimens on vancomycin target levels in critically ill patients: continuous versus intermittent application. J. Infect. Public Health. 2015;8:355‐363.
    1. Saugel B, Gramm C, Wagner JY, et al. Evaluation of a dosing regimen for continuous vancomycin infusion in critically ill patients: an observational study in intensive care unit patients. J. Crit. Care. 2014;29:351‐355.
    1. Eldemiry EM, Sabry NA, Abbassi MM, Abdel Shafy SS, Mokhtar MS, Abdel Bary A. A specially tailored vancomycin continuous infusion regimen for renally impaired critically ill patients. SAGE Open Med. 2013;1:2050312113507921.
    1. Chuma M, Makishima M, Imai T, et al. Duration of systemic inflammatory response syndrome influences serum vancomycin concentration in patients with sepsis. Clin. Ther. 2016;38:2598‐2609.
    1. Roberts JA, Taccone FS, Udy AA, Vincent JL, Jacobs F, Lipman J. Vancomycin dosing in critically ill patients: robust methods for improved continuous‐infusion regimens. Antimicrob. Agents Chemother. 2011;55:2704‐2709.
    1. de Gatta MD, Revilla N, Calvo MV, Domínguez‐Gil A, Navarro AS. Pharmacokinetic/pharmacodynamic analysis of vancomycin in ICU patients. Intensive Care Med. 2007;33:279‐285.
    1. Arfa P, Karimi A, Rafiei Tabatabaei S, Fahimzad A, Armin S, Sistanizad M. A prospective study to assess vancomycin serum concentrations inpediatric patients with current dosing guidelines. IJPR. 2016;15:341‐346.
    1. Hirai K, Ihara S, Kinae A, et al. Augmented renal clearance in pediatric patients with febrile neutropenia associated with vancomycin clearance. Ther. Drug Monit. 2016;38:393‐397.
    1. Kishk OA, Lardieri AB, Heil EL, Morgan JA. Vancomycin AUC/MIC and corresponding troughs in a pediatric population. JPPT. 2017;22:41‐47.
    1. Balch AH, Constance JE, Thorell EA, et al. Pediatric vancomycin dosing: trends over time and the impact of therapeutic drug monitoring. J. Clin. Pharmacol. 2015;55:212‐220.
    1. Moffett BS, Edwards MS. Analysis of vancomycin therapeutic drug monitoring trends at pediatric hospitals. Pediatr. Infect. Dis. J. 2013;32:32‐35.
    1. Heble DE Jr, McPherson C, Nelson MP, Hunstad DA. Vancomycin trough concentrations in overweight or obese pediatric patients. Pharmacotherapy. 2013;33:1273‐1277.
    1. Guilhaumou R, Marsot A, Dupouey J, et al. Pediatric patients with solid or hematological tumor disease: vancomycin population pharmacokinetics and dosage optimization. Ther. Drug Monit. 2016;38:559‐566.
    1. Le J, Ngu B, Bradley JS, et al. Vancomycin monitoring in children using bayesian estimation. Ther. Drug Monit. 2014;36:510‐518.
    1. Hahn A, Frenck RW Jr, Zou Y, Vinks AA. Validation of a pediatric population pharmacokinetic model for vancomycin. Ther. Drug Monit. 2015;37:413‐416.
    1. Wrishko RE, Levine M, Khoo D, Abbott P, Hamilton D. Vancomycin pharmacokinetics and Bayesian estimation in pediatric patients. Ther. Drug Monit. 2000;22:522‐531.
    1. Lamarre P, Lebel D, Ducharme MP. A population pharmacokinetic model for vancomycin in pediatric patients and its predictive value in a naive population. Antimicrob. Agents Chemother. 2000;44:278‐282.
    1. Stockmann C, Sherwin CM, Zobell JT, et al. Population pharmacokinetics of intermittent vancomycin in children with cystic fibrosis. Pharmacotherapy. 2013;33:1288‐1296.
    1. Bhongsatiern J, Stockmann C, Roberts JK, et al. Evaluation of vancomycin use in late‐onset neonatal sepsis using the area under the concentration‐time curve to the minimum inhibitory concentration >/=400 target. Ther. Drug Monit. 2015;37:756‐765.
    1. Frymoyer A, Hersh AL, El‐Komy MH, et al. Association between vancomycin trough concentration and area under the concentration‐time curve in neonates. Antimicrob. Agents Chemother. 2014;58:6454‐6461.
    1. Marques‐Minana MR, Saadeddin A, Peris JE. Population pharmacokinetic analysis of vancomycin in neonates. A new proposal of initial dosage guideline. Br. J. Clin. Pharmacol. 2010;70:713‐720.
    1. Capparelli EV, Lane JR, Romanowski GL, et al. The influences of renal function and maturation on vancomycin elimination in newborns and infants. J. Clin. Pharmacol. 2001;41:927‐934.
    1. Rodvold KA, Gentry CA, Plank GS, Kraus DM, Nickel E, Gross JR. Bayesian forecasting of serum vancomycin concentrations in neonates and infants. Ther. Drug Monit. 1995;17:239‐246.
    1. Mehrotra N, Tang L, Phelps SJ, Meibohm B. Evaluation of vancomycin dosing regimens in preterm and term neonates using Monte Carlo simulations. Pharmacotherapy. 2012;32:408‐419.
    1. McDade EJ, Hewlett JL, Moonnumakal SP, Baker CJ. Evaluation of vancomycin dosing in pediatric cystic fibrosis patients. JPPT. 2016;21:155‐161.
    1. Jacqz‐Aigrain E, Leroux S, Zhao W, van den Anker JN, Sharland M. How to use vancomycin optimally in neonates: remaining questions. Expert Rev. Clin. Pharmacol. 2015;8:635‐648.
    1. Roberts JK, Stockmann C, Constance JE, et al. Pharmacokinetics and pharmacodynamics of antibacterials, antifungals, and antivirals used most frequently in neonates and infants. Clin. Pharmacokinet. 2014;53:581‐610.
    1. Hammer BM, Lardieri AB, Morgan JA. Appropriate use of vancomycin in NICU despite free‐for‐all policy. JPPT. 2016;21:207‐212.
    1. Pauwels S, Allegaert K. Therapeutic drug monitoring in neonates. Arch. Dis. Child. 2016;101:377‐381.
    1. Padari H, Oselin K, Tasa T, Metsvaht T, Loivukene K, Lutsar I. Coagulase negative staphylococcal sepsis in neonates: do we need to adapt vancomycin dose or target? BMC Pediatr. 2016;16:206.
    1. Vandendriessche A, Allegaert K, Cossey V, Naulaers G, Saegeman V, Smits A. Prospective validation of neonatal vancomycin dosing regimens is urgently needed. Curr. Ther. Res. Clin. Exp. 2014;76:51‐57.
    1. Pacifici GM, Allegaert K. Clinical pharmacokinetics of vancomycin in the neonate: a review. Clinics. 2012;67:831‐837.
    1. Badran EF, Shamayleh A, Irshaid YM. Pharmacokinetics of vancomycin in neonates admitted to the neonatology unit at the Jordan University Hospital. Int. J. Clin. Pharmacol. Ther. 2011;49:252‐257.
    1. Oudin C, Vialet R, Boulamery A, Martin C, Simon N. Vancomycin prescription in neonates and young infants: toward a simplified dosage. Arch. Dis. Child. Fetal Neonatal Ed. 2011;96:F365‐F370.
    1. Gwee A, Cranswick N, Metz D, et al. Neonatal vancomycin continuous infusion: still a confusion? Pediatr. Infect. Dis. J. 2014;33:600‐605.
    1. Zhao W, Lopez E, Biran V, Durrmeyer X, Fakhoury M, Jacqz‐Aigrain E. Vancomycin continuous infusion in neonates: dosing optimisation and therapeutic drug monitoring. Arch. Dis. Child. 2013;98:449‐453.
    1. Jacqz‐Aigrain E, Zhao W, Sharland M, van den Anker JN. Use of antibacterial agents in the neonate: 50 years of experience with vancomycin administration. Semin. Fetal Neonatal. Med. 2013;18:28‐34.
    1. Samardzic J, Allegaert K, Wilbaux M, Pfister M, van den Anker JN. Quantitative clinical pharmacology practice for optimal use of antibiotics during the neonatal period. Expert Opin. Drug Metab. Toxicol. 2016;12:367‐375.
    1. Marsot A, Vialet R, Boulamery A, Bruguerolle B, Simon N. Vancomycin: predictive performance of a population pharmacokinetic model and optimal dose in neonates and young infants. Clin. Pharmacol. Drug Develop. 2012;1:144‐151.
    1. Leroux S, Jacqz‐Aigrain E, Biran V, et al. Clinical utility and safety of a model‐based patient‐tailored dose of vancomycin in neonates. Antimicrob. Agents Chemother. 2016;60:2039‐2042.
    1. Bel Kamel A, Bourguignon L, Marcos M, Ducher M, Goutelle S. Is trough concentration of vancomycin predictive of the area under the curve? A clinical study in elderly patients. Ther. Drug Monit. 2017;39:83‐87.
    1. Fukumori S, Tsuji Y, Mizoguchi A, et al. Association of the clinical efficacy of vancomycin with the novel pharmacokinetic parameter area under the trough level (AUTL) in elderly patients with hospital‐acquired pneumonia. J. Clin. Pharm. Ther. 2016;41:399‐402.
    1. Kosmisky DE, Griffiths CL, Templin MA, Norton J, Martin KE. Evaluation of a new vancomycin dosing protocol in morbidly obese patients. Hospital Pharm. 2015;50:789‐797.
    1. Tafelski S, Yi H, Ismaeel F, Krannich A, Spies C, Nachtigall I. Obesity in critically ill patients is associated with increased need of mechanical ventilation but not with mortality. J. Infect. Public Health. 2016;9:577‐585.
    1. Abuhasna S, Al Jundi AH. Therapeutic drug monitoring of vancomycin in an obese patient with renal insufficiency. J. Anaesthesiol. Clin. Pharmacol. 2011;27:531‐533.
    1. Grupper M, Nicolau DP. Obesity and skin and soft tissue infections: how to optimize antimicrobial usage for prevention and treatment? Curr. Opin. Infect. Dis. 2017;30:180‐191.
    1. Hong J, Krop LC, Johns T, Pai MP. Individualized vancomycin dosing in obese patients: a two‐sample measurement approach improves target attainment. Pharmacotherapy. 2015;35:455‐463.
    1. Chu Y, Luo Y, Qu L, Zhao C, Jiang M. Application of vancomycin in patients with varying renal function, especially those with augmented renal clearance. Pharm. Biol. 2016;54:2802‐2806.
    1. Hurst AK, Yoshinaga MA, Mitani GH, Foo KA, Jelliffe RW, Harrison EC. Application of a Bayesian method to monitor and adjust vancomycin dosage regimens. Antimicrob. Agents Chemother. 1990;34:1165‐1171.
    1. Schaedeli F, Uehlinger DE. Urea kinetics and dialysis treatment time predict vancomycin elimination during high‐flux hemodialysis. Clin. Pharmacol. Ther. 1998;63:26‐38.
    1. Montanes Pauls B, Alminana MA, Casabo Alos VG. Vancomycin pharmacokinetics during continuous ambulatory peritoneal dialysis in patients with peritonitis. Eur. J. Pharm. Sci. 2011;43:212‐216.
    1. van de Vijsel LM, Walker SA, Walker SE, Yamashita S, Simor A, Hladunewich M. Initial vancomycin dosing recommendations for critically ill patients undergoing continuous venovenous hemodialysis. Can. J. Hosp. Pharm. 2010;63:196‐206.
    1. Crew P, Heintz SJ, Heintz BH. Vancomycin dosing and monitoring for patients with end‐stage renal disease receiving intermittent hemodialysis. AJHP. 2015;72:1856‐1864.
    1. Golestaneh L, Gofran A, Mokrzycki MH, Chen JL. Removal of vancomycin in sustained low‐efficiency dialysis (SLED): a need for better surveillance and dosing. Clin. Nephrol. 2009;72:286‐291.
    1. Roberts DM, Liu X, Roberts JA, et al. A multicenter study on the effect of continuous hemodiafiltration intensity on antibiotic pharmacokinetics. Crit. Care. 2015;19:84.
    1. Akers KS, Cota JM, Chung KK, Renz EM, Mende K, Murray CK. Serum vancomycin levels resulting from continuous or intermittent infusion in critically ill burn patients with or without continuous renal replacement therapy. J. Burn Care Res. 2012;33:e254‐e262.
    1. Stevenson S, Tang W, Cho Y, et al. The role of monitoring vancomycin levels in patients with peritoneal dialysis‐associated peritonitis. Perit. Dial. Int. 2015;35:222‐228.
    1. Dolton M, Xu H, Cheong E, et al. Vancomycin pharmacokinetics in patients with severe burn injuries. Burns. 2010;36:469‐476.
    1. Omote S, Yano Y, Hashida T, et al. A retrospective analysis of vancomycin pharmacokinetics in Japanese cancer and non‐cancer patients based on routine trough monitoring data. Biol. Pharm. Bull. 2009;32:99‐104.
    1. Suzuki Y, Tokimatsu I, Morinaga Y, et al. A retrospective analysis to estimate target trough concentration of vancomycin for febrile neutropenia in patients with hematological malignancy. Clin. Chim. Acta. 2015;440:183‐187.
    1. Luo C, Hussaini T, Lacaria K, Yeung J, Lau TT, Broady RC. Evaluation of a once‐daily vancomycin regimen in an outpatient leukemia/bone marrow transplant clinic (OD‐VANCO Study). Can. J. Hospital Pharm. 2014;67:280‐285.
    1. Jarkowski A 3rd, Forrest A, Sweeney RP, et al. Characterization of vancomycin pharmacokinetics in the adult acute myeloid leukemia population. J. Oncol. Pharm. Pract. 2012;18:91‐96.
    1. Zhao W, Zhang D, Fakhoury M, et al. Population pharmacokinetics and dosing optimization of vancomycin in children with malignant hematological disease. Antimicrob. Agents Chemother. 2014;58:3191‐3199.
    1. Ghehi MT, Rezaee S, Hayatshahi A, et al. Vancomycin pharmacokinetic parameters in patients undergoing hematopoietic stem cell transplantation (HSCT). Int. J. Hematol. Ther. 2013;7:1‐9.
    1. Kim AJ, Lee JY, Choi SA, Shin WG. Comparison of the pharmacokinetics of vancomycin in neurosurgical and non‐neurosurgical patients. Int. J. Antimicrob. Agents. 2016;48:381‐387.
    1. Lin Wu FL, Liu SS, Yang TY, et al. A larger dose of vancomycin is required in adult neurosurgical intensive care unit patients due to augmented clearance. Ther. Drug Monit. 2015;37:609‐618.
    1. Lonsdale DO, Udy AA, Roberts JA, Lipman J. Antibacterial therapeutic drug monitoring in cerebrospinal fluid: difficulty in achieving adequate drug concentrations. J. Neurosurg. 2013;118:297‐301.
    1. Li X, Wu Y, Sun S, et al. Population pharmacokinetics of vancomycin in postoperative neurosurgical patients. J. Pharm. Sci. 2015;104:3960‐3967.
    1. DeCarolis DD, Thorson JG, Marraffa RA, Clairmont MA, Kuskowski MA. Comparison of equations with estimate renal function to predict serum vancomycin concentration in patients with spinal cord injury–does the use of cystatin C improve accuracy? Ther. Drug Monit. 2014;36:632‐639.
    1. Popa D, Loewenstein L, Lam SW, Neuner EA, Ahrens CL, Bhimraj A. Therapeutic drug monitoring of cerebrospinal fluid vancomycin concentration during intraventricular administration. J. Hospital Infect. 2016;92:199‐202.
    1. Ng K, Mabasa VH, Chow I, Ensom MH. Systematic review of efficacy, pharmacokinetics, and administration of intraventricular vancomycin in adults. Neurocrit. Care. 2014;20:158‐171.
    1. He J, Mao EQ, Feng J, Jiang HT, Yang WH, Chen EZ. The pharmacokinetics of vancomycin in patients with severe acute pancreatitis. Eur. J. Clin. Pharmacol. 2016;72:697‐702.
    1. Medellin‐Garibay SE, Ortiz‐Martin B, Rueda‐Naharro A, Garcia B, Romano‐Moreno S, Barcia E. Pharmacokinetics of vancomycin and dosing recommendations for trauma patients. J. Antimicrob. Chemother. 2016;71:471‐479.
    1. Wu CC, Shen LJ, Hsu LF, Ko WJ, Wu FL. Pharmacokinetics of vancomycin in adults receiving extracorporeal membrane oxygenation. JFMA. 2016;115:560‐570.
    1. Lemaitre F, Hasni N, Leprince P, et al. Propofol, midazolam, vancomycin and cyclosporine therapeutic drug monitoring in extracorporeal membrane oxygenation circuits primed with whole human blood. Crit. Care. 2015;19:40.
    1. Donadello K, Roberts JA, Cristallini S, et al. Vancomycin population pharmacokinetics during extracorporeal membrane oxygenation therapy: a matched cohort study. Crit. Care. 2014;18:632.
    1. Payne CJ, Carmichael SJ, Stearns AT, Kingsmore DB, Byrne DS, Binning AR. Vancomycin continuous infusion as prophylaxis for vascular surgery. Ther. Drug Monit. 2009;31:786‐788.
    1. Davis SL, Scheetz MH, Bosso JA, Goff DA, Rybak MJ. Adherence to the 2009 consensus guidelines for vancomycin dosing and monitoring practices: a cross‐sectional survey of U.S. hospitals. Pharmacotherapy. 2013;33:1256‐1263.

Source: PubMed

Sponsorer och medarbetare

Medicinska tillstånd

Läkemedelsinterventioner

3
Prenumerera