CP-207 Analysis of frequency of underdosing in obese patients treated with vancomycin
BackgroundObese patients with normal serum creatinine have increased renal clearance, and consequently the dose of some drugs, such as vancomycin, should be dosed based on actual body weight (ABW). According to the American Society of Health-System Pharmacists (ASHP) guidelines, the recommended dosi...
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| Veröffentlicht in: | European journal of hospital pharmacy. Science and practice 2017-03, Vol.24 (Suppl 1), p.A92-A93 |
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| container_title | European journal of hospital pharmacy. Science and practice |
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| creator | Ortega, P Ranz Nuñez, ME Martínez Sánchez, R Vázquez González, A Onteniente García, T Molina |
| description | BackgroundObese patients with normal serum creatinine have increased renal clearance, and consequently the dose of some drugs, such as vancomycin, should be dosed based on actual body weight (ABW). According to the American Society of Health-System Pharmacists (ASHP) guidelines, the recommended dosing regimen is 15–20 mg/kg ABW/12 hours intravenously, with subsequent dosage adjustment based on serum vancomycin concentrations. Nevertheless, in our hospital, vancomycin is often used as a fixed dose regimen regardless of patient weight, based on the manufacturer´s labelling recommendation.PurposeTo determine the frequency of underdosing of vancomycin in obese patients and possible risk factors.Material and methodsA single centre, retrospective, observational study from January 2014 to September 2016 was carried out. Morbidly obese adult patients, defined as a body mass index (BMI) ≥ 30 according to the WHO classification, with at least one trough level obtained at steady state, were included. Patients were excluded if they had a creatinine clearance (CrCl) 65 years (OR 0.206, 95% CI 0.04–0.98; p< 0.05) and initial dosing regimen of 1000 mg/12 hours (OR 0.008, 95% CI 0.0–0.55; p< 0.05) compared with 1000 mg/24 hours.ConclusionIt is important to monitor levels of vancomycin in obese patients, especially in those aged |
| doi_str_mv | 10.1136/ejhpharm-2017-000640.205 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_bmj_p</sourceid><recordid>TN_cdi_proquest_journals_2552764242</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>4317856541</sourcerecordid><originalsourceid>FETCH-LOGICAL-b1002-66ddd47c5c60f8b7f85c09b5957a8b97f9be1679a146d220cade0940e04fe03c3</originalsourceid><addsrcrecordid>eNp9kE1Lw0AQhhdRsGj_w4Ln1Nnv7LEUv6CgB8Vj2K_YLU1Sd1MlNy_-UX-JKVWPnuYdeGaYeRDCBGaEMHkZ1qvtyqSmoEBUAQCSw4yCOEITClwVWkt-_JeFPEXTnKMFwVipOdMT9Lx4GIfV18fnvDWbIceMuxrXKbzuQuuGfbNrfUi-y7F9wbHFnQ054K3pY2j7jPsUTB88fo_9Cr-Z1nXN4GJ7jk5qs8lh-lPP0NP11ePitlje39wt5svCEgBaSOm958oJJ6EurapL4UBboYUypdWq1jYQqbQhXHpKwRkfQHMIwOsAzLEzdHHYu03deHLuq3W3S-MruaJCUCU55fQ_ipSKjTa4ViPFDpRt1tU2xcakoSJQ7VVXv6qrverqoHrMgn0D-hdzzw</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1873338497</pqid></control><display><type>article</type><title>CP-207 Analysis of frequency of underdosing in obese patients treated with vancomycin</title><source>EZB-FREE-00999 freely available EZB journals</source><source>PubMed Central</source><creator>Ortega, P Ranz ; Nuñez, ME Martínez ; Sánchez, R Vázquez ; González, A Onteniente ; García, T Molina</creator><creatorcontrib>Ortega, P Ranz ; Nuñez, ME Martínez ; Sánchez, R Vázquez ; González, A Onteniente ; García, T Molina</creatorcontrib><description>BackgroundObese patients with normal serum creatinine have increased renal clearance, and consequently the dose of some drugs, such as vancomycin, should be dosed based on actual body weight (ABW). According to the American Society of Health-System Pharmacists (ASHP) guidelines, the recommended dosing regimen is 15–20 mg/kg ABW/12 hours intravenously, with subsequent dosage adjustment based on serum vancomycin concentrations. Nevertheless, in our hospital, vancomycin is often used as a fixed dose regimen regardless of patient weight, based on the manufacturer´s labelling recommendation.PurposeTo determine the frequency of underdosing of vancomycin in obese patients and possible risk factors.Material and methodsA single centre, retrospective, observational study from January 2014 to September 2016 was carried out. Morbidly obese adult patients, defined as a body mass index (BMI) ≥ 30 according to the WHO classification, with at least one trough level obtained at steady state, were included. Patients were excluded if they had a creatinine clearance (CrCl) <35 mL/min, calculated by the Salazar–Corcoran formula. The therapeutic level for serious infections (endocarditis, osteomyelitis, meningitis, nosocomial pneumonia by Staphylococcus aureus, methicillin resistant Staphylococcus aureus bacteraemia) was 15–20 mg/mL, whereas for uncomplicated infections the optimal interval was 10–15 mg/mL, according to the ASHP guidelines. Binary logistic regression was done to identify variables associated with underdosing, using SPSS 15.0.Results46 patients were included, 63% women. Mean age±SD=70.78±12.5 years; mean weight±SD=87.8±13.9 kg; and mean height 1.59±0.09 m. 34.8% were underdosed. No association was found between gender and underdose (p=0.143), or BMI classification (p=0.679) or creatinine (p=0.079). On the other hand, statistical analysis suggested a relationship between underdose and age >65 years (OR 0.206, 95% CI 0.04–0.98; p< 0.05) and initial dosing regimen of 1000 mg/12 hours (OR 0.008, 95% CI 0.0–0.55; p< 0.05) compared with 1000 mg/24 hours.ConclusionIt is important to monitor levels of vancomycin in obese patients, especially in those aged <65 years and with an initial dosing regimen not adjusted to patient weight. Even so, there are currently insufficient data to make statements to guide vancomycin dosing in obese patients, so it is necessary for more studies to focus on this issue.References and/or acknowledgementsAmerican Society of Health-System Pharmacists (ASHP) guidelines.No conflict of interest</description><identifier>ISSN: 2047-9956</identifier><identifier>EISSN: 2047-9964</identifier><identifier>DOI: 10.1136/ejhpharm-2017-000640.205</identifier><language>eng</language><publisher>London: BMJ Publishing Group LTD</publisher><subject>Antibiotics ; Creatinine ; Patients ; Pharmacists</subject><ispartof>European journal of hospital pharmacy. Science and practice, 2017-03, Vol.24 (Suppl 1), p.A92-A93</ispartof><rights>2017, Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions</rights><rights>Copyright: 2017 (c) 2017, Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions</rights><rights>2017 2017, Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids></links><search><creatorcontrib>Ortega, P Ranz</creatorcontrib><creatorcontrib>Nuñez, ME Martínez</creatorcontrib><creatorcontrib>Sánchez, R Vázquez</creatorcontrib><creatorcontrib>González, A Onteniente</creatorcontrib><creatorcontrib>García, T Molina</creatorcontrib><title>CP-207 Analysis of frequency of underdosing in obese patients treated with vancomycin</title><title>European journal of hospital pharmacy. Science and practice</title><description>BackgroundObese patients with normal serum creatinine have increased renal clearance, and consequently the dose of some drugs, such as vancomycin, should be dosed based on actual body weight (ABW). According to the American Society of Health-System Pharmacists (ASHP) guidelines, the recommended dosing regimen is 15–20 mg/kg ABW/12 hours intravenously, with subsequent dosage adjustment based on serum vancomycin concentrations. Nevertheless, in our hospital, vancomycin is often used as a fixed dose regimen regardless of patient weight, based on the manufacturer´s labelling recommendation.PurposeTo determine the frequency of underdosing of vancomycin in obese patients and possible risk factors.Material and methodsA single centre, retrospective, observational study from January 2014 to September 2016 was carried out. Morbidly obese adult patients, defined as a body mass index (BMI) ≥ 30 according to the WHO classification, with at least one trough level obtained at steady state, were included. Patients were excluded if they had a creatinine clearance (CrCl) <35 mL/min, calculated by the Salazar–Corcoran formula. The therapeutic level for serious infections (endocarditis, osteomyelitis, meningitis, nosocomial pneumonia by Staphylococcus aureus, methicillin resistant Staphylococcus aureus bacteraemia) was 15–20 mg/mL, whereas for uncomplicated infections the optimal interval was 10–15 mg/mL, according to the ASHP guidelines. Binary logistic regression was done to identify variables associated with underdosing, using SPSS 15.0.Results46 patients were included, 63% women. Mean age±SD=70.78±12.5 years; mean weight±SD=87.8±13.9 kg; and mean height 1.59±0.09 m. 34.8% were underdosed. No association was found between gender and underdose (p=0.143), or BMI classification (p=0.679) or creatinine (p=0.079). On the other hand, statistical analysis suggested a relationship between underdose and age >65 years (OR 0.206, 95% CI 0.04–0.98; p< 0.05) and initial dosing regimen of 1000 mg/12 hours (OR 0.008, 95% CI 0.0–0.55; p< 0.05) compared with 1000 mg/24 hours.ConclusionIt is important to monitor levels of vancomycin in obese patients, especially in those aged <65 years and with an initial dosing regimen not adjusted to patient weight. Even so, there are currently insufficient data to make statements to guide vancomycin dosing in obese patients, so it is necessary for more studies to focus on this issue.References and/or acknowledgementsAmerican Society of Health-System Pharmacists (ASHP) guidelines.No conflict of interest</description><subject>Antibiotics</subject><subject>Creatinine</subject><subject>Patients</subject><subject>Pharmacists</subject><issn>2047-9956</issn><issn>2047-9964</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp9kE1Lw0AQhhdRsGj_w4Ln1Nnv7LEUv6CgB8Vj2K_YLU1Sd1MlNy_-UX-JKVWPnuYdeGaYeRDCBGaEMHkZ1qvtyqSmoEBUAQCSw4yCOEITClwVWkt-_JeFPEXTnKMFwVipOdMT9Lx4GIfV18fnvDWbIceMuxrXKbzuQuuGfbNrfUi-y7F9wbHFnQ054K3pY2j7jPsUTB88fo_9Cr-Z1nXN4GJ7jk5qs8lh-lPP0NP11ePitlje39wt5svCEgBaSOm958oJJ6EurapL4UBboYUypdWq1jYQqbQhXHpKwRkfQHMIwOsAzLEzdHHYu03deHLuq3W3S-MruaJCUCU55fQ_ipSKjTa4ViPFDpRt1tU2xcakoSJQ7VVXv6qrverqoHrMgn0D-hdzzw</recordid><startdate>201703</startdate><enddate>201703</enddate><creator>Ortega, P Ranz</creator><creator>Nuñez, ME Martínez</creator><creator>Sánchez, R Vázquez</creator><creator>González, A Onteniente</creator><creator>García, T Molina</creator><general>BMJ Publishing Group LTD</general><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>BTHHO</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope></search><sort><creationdate>201703</creationdate><title>CP-207 Analysis of frequency of underdosing in obese patients treated with vancomycin</title><author>Ortega, P Ranz ; Nuñez, ME Martínez ; Sánchez, R Vázquez ; González, A Onteniente ; García, T Molina</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-b1002-66ddd47c5c60f8b7f85c09b5957a8b97f9be1679a146d220cade0940e04fe03c3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Antibiotics</topic><topic>Creatinine</topic><topic>Patients</topic><topic>Pharmacists</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Ortega, P Ranz</creatorcontrib><creatorcontrib>Nuñez, ME Martínez</creatorcontrib><creatorcontrib>Sánchez, R Vázquez</creatorcontrib><creatorcontrib>González, A Onteniente</creatorcontrib><creatorcontrib>García, T Molina</creatorcontrib><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>BMJ Journals</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><jtitle>European journal of hospital pharmacy. Science and practice</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Ortega, P Ranz</au><au>Nuñez, ME Martínez</au><au>Sánchez, R Vázquez</au><au>González, A Onteniente</au><au>García, T Molina</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>CP-207 Analysis of frequency of underdosing in obese patients treated with vancomycin</atitle><jtitle>European journal of hospital pharmacy. Science and practice</jtitle><date>2017-03</date><risdate>2017</risdate><volume>24</volume><issue>Suppl 1</issue><spage>A92</spage><epage>A93</epage><pages>A92-A93</pages><issn>2047-9956</issn><eissn>2047-9964</eissn><abstract>BackgroundObese patients with normal serum creatinine have increased renal clearance, and consequently the dose of some drugs, such as vancomycin, should be dosed based on actual body weight (ABW). According to the American Society of Health-System Pharmacists (ASHP) guidelines, the recommended dosing regimen is 15–20 mg/kg ABW/12 hours intravenously, with subsequent dosage adjustment based on serum vancomycin concentrations. Nevertheless, in our hospital, vancomycin is often used as a fixed dose regimen regardless of patient weight, based on the manufacturer´s labelling recommendation.PurposeTo determine the frequency of underdosing of vancomycin in obese patients and possible risk factors.Material and methodsA single centre, retrospective, observational study from January 2014 to September 2016 was carried out. Morbidly obese adult patients, defined as a body mass index (BMI) ≥ 30 according to the WHO classification, with at least one trough level obtained at steady state, were included. Patients were excluded if they had a creatinine clearance (CrCl) <35 mL/min, calculated by the Salazar–Corcoran formula. The therapeutic level for serious infections (endocarditis, osteomyelitis, meningitis, nosocomial pneumonia by Staphylococcus aureus, methicillin resistant Staphylococcus aureus bacteraemia) was 15–20 mg/mL, whereas for uncomplicated infections the optimal interval was 10–15 mg/mL, according to the ASHP guidelines. Binary logistic regression was done to identify variables associated with underdosing, using SPSS 15.0.Results46 patients were included, 63% women. Mean age±SD=70.78±12.5 years; mean weight±SD=87.8±13.9 kg; and mean height 1.59±0.09 m. 34.8% were underdosed. No association was found between gender and underdose (p=0.143), or BMI classification (p=0.679) or creatinine (p=0.079). On the other hand, statistical analysis suggested a relationship between underdose and age >65 years (OR 0.206, 95% CI 0.04–0.98; p< 0.05) and initial dosing regimen of 1000 mg/12 hours (OR 0.008, 95% CI 0.0–0.55; p< 0.05) compared with 1000 mg/24 hours.ConclusionIt is important to monitor levels of vancomycin in obese patients, especially in those aged <65 years and with an initial dosing regimen not adjusted to patient weight. Even so, there are currently insufficient data to make statements to guide vancomycin dosing in obese patients, so it is necessary for more studies to focus on this issue.References and/or acknowledgementsAmerican Society of Health-System Pharmacists (ASHP) guidelines.No conflict of interest</abstract><cop>London</cop><pub>BMJ Publishing Group LTD</pub><doi>10.1136/ejhpharm-2017-000640.205</doi></addata></record> |
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| title | CP-207 Analysis of frequency of underdosing in obese patients treated with vancomycin |
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