Loading dose of vancomycin in critically ill patients: 15 mg/kg is a better choice than 500 mg
Delays in antimicrobial therapy in high-risk patients with infection may have deleterious effects on clinical outcomes. Therefore, appropriate treatment must be initiated promptly. The objective of this prospective study was to determine the better loading dose of vancomycin in critically ill patien...
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| Veröffentlicht in: | International journal of antimicrobial agents 2006-03, Vol.27 (3), p.259-262 |
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| container_title | International journal of antimicrobial agents |
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| creator | Mohammedi, I. Descloux, E. Argaud, L. Le Scanff, J. Robert, D. |
| description | Delays in antimicrobial therapy in high-risk patients with infection may have deleterious effects on clinical outcomes. Therefore, appropriate treatment must be initiated promptly. The objective of this prospective study was to determine the better loading dose of vancomycin in critically ill patients with suspected Gram-positive infections. Two groups of patients were studied successively: Group A, loading dose of 500
mg; and Group B, loading dose of 15
mg/kg. The mean post-loading dose serum vancomycin concentration was significantly higher in Group B than in Group A (19.1
±
7.4
mg/L versus 10.4
±
2.7
mg/L;
P
<
0.001), without producing toxic peak levels. Clinical cure rates were significantly different for infected patients in Group B compared with Group A: 93% (14 of 15 patients) versus 56% (10 of 18 patients), respectively. However, the proportion of patients surviving to Intensive Care Unit discharge was similar. Because vancomycin is believed to achieve maximum killing at concentrations in serum of four to five times the minimum inhibitory concentration for the infecting organism, our results suggest that the 15
mg/kg loading dose should be preferred. |
| doi_str_mv | 10.1016/j.ijantimicag.2005.11.009 |
| format | Article |
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mg; and Group B, loading dose of 15
mg/kg. The mean post-loading dose serum vancomycin concentration was significantly higher in Group B than in Group A (19.1
±
7.4
mg/L versus 10.4
±
2.7
mg/L;
P
<
0.001), without producing toxic peak levels. Clinical cure rates were significantly different for infected patients in Group B compared with Group A: 93% (14 of 15 patients) versus 56% (10 of 18 patients), respectively. However, the proportion of patients surviving to Intensive Care Unit discharge was similar. Because vancomycin is believed to achieve maximum killing at concentrations in serum of four to five times the minimum inhibitory concentration for the infecting organism, our results suggest that the 15
mg/kg loading dose should be preferred.</description><identifier>ISSN: 0924-8579</identifier><identifier>EISSN: 1872-7913</identifier><identifier>DOI: 10.1016/j.ijantimicag.2005.11.009</identifier><identifier>PMID: 16472993</identifier><language>eng</language><publisher>London: Elsevier B.V</publisher><subject>Aged ; Antibiotics. Antiinfectious agents. Antiparasitic agents ; Biological and medical sciences ; Critical Illness ; Dose-Response Relationship, Drug ; Female ; Gram-Positive Bacterial Infections - drug therapy ; Gram-Positive Bacterial Infections - microbiology ; Humans ; ICU ; Intensive Care Units ; Loading dose ; Male ; Medical sciences ; Middle Aged ; Pharmacology. Drug treatments ; Vancomycin ; Vancomycin - administration & dosage</subject><ispartof>International journal of antimicrobial agents, 2006-03, Vol.27 (3), p.259-262</ispartof><rights>2006 Elsevier B.V. and the International Society of Chemotherapy</rights><rights>2006 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0924857906000161$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3536,27903,27904,65309</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=17546470$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/16472993$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Mohammedi, I.</creatorcontrib><creatorcontrib>Descloux, E.</creatorcontrib><creatorcontrib>Argaud, L.</creatorcontrib><creatorcontrib>Le Scanff, J.</creatorcontrib><creatorcontrib>Robert, D.</creatorcontrib><title>Loading dose of vancomycin in critically ill patients: 15 mg/kg is a better choice than 500 mg</title><title>International journal of antimicrobial agents</title><addtitle>Int J Antimicrob Agents</addtitle><description>Delays in antimicrobial therapy in high-risk patients with infection may have deleterious effects on clinical outcomes. Therefore, appropriate treatment must be initiated promptly. The objective of this prospective study was to determine the better loading dose of vancomycin in critically ill patients with suspected Gram-positive infections. Two groups of patients were studied successively: Group A, loading dose of 500
mg; and Group B, loading dose of 15
mg/kg. The mean post-loading dose serum vancomycin concentration was significantly higher in Group B than in Group A (19.1
±
7.4
mg/L versus 10.4
±
2.7
mg/L;
P
<
0.001), without producing toxic peak levels. Clinical cure rates were significantly different for infected patients in Group B compared with Group A: 93% (14 of 15 patients) versus 56% (10 of 18 patients), respectively. However, the proportion of patients surviving to Intensive Care Unit discharge was similar. Because vancomycin is believed to achieve maximum killing at concentrations in serum of four to five times the minimum inhibitory concentration for the infecting organism, our results suggest that the 15
mg/kg loading dose should be preferred.</description><subject>Aged</subject><subject>Antibiotics. Antiinfectious agents. Antiparasitic agents</subject><subject>Biological and medical sciences</subject><subject>Critical Illness</subject><subject>Dose-Response Relationship, Drug</subject><subject>Female</subject><subject>Gram-Positive Bacterial Infections - drug therapy</subject><subject>Gram-Positive Bacterial Infections - microbiology</subject><subject>Humans</subject><subject>ICU</subject><subject>Intensive Care Units</subject><subject>Loading dose</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Pharmacology. Drug treatments</subject><subject>Vancomycin</subject><subject>Vancomycin - administration & dosage</subject><issn>0924-8579</issn><issn>1872-7913</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2006</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpNkUtrGzEURkVpaBy3f6Goi3Y3k6vXaJRdMc0DDNkk2wqN5o4jdx7uSDb431cmDg1c0OZwdb_zEfKNQcmAVdfbMmzdmMIQvNuUHECVjJUA5gNZsFrzQhsmPpIFGC6LWmlzSa5i3AIwJaT6RC5ZJTU3RizI7_Xk2jBuaDtFpFNHD27003D0YaR5_BxS_qTvjzT0Pd25FHBM8YYyRYfN9Z8NDZE62mBKOFP_MgWPNL24kSqATHwmF53rI345v0vyfPvraXVfrB_vHlY_1wUKAanAFkGqVtaN6iRTVc21bpQ0ouaNR6V1DuS0V7qSHWjHmUeEyhivGo7CeLEkP1737ubp7x5jskOIHvvejTjto82ONNdQZfDrGdw3A7Z2N4fBzUf7ZiQD38-Aizl4N2cfIf7ntJIZhcytXjnMsQ4BZxt9duOxDTP6ZNspWAb21Jfd2nd9nW5RljGb-xL_ADBniNc</recordid><startdate>20060301</startdate><enddate>20060301</enddate><creator>Mohammedi, I.</creator><creator>Descloux, E.</creator><creator>Argaud, L.</creator><creator>Le Scanff, J.</creator><creator>Robert, D.</creator><general>Elsevier B.V</general><general>Elsevier</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>7QL</scope><scope>7T7</scope><scope>8FD</scope><scope>C1K</scope><scope>FR3</scope><scope>P64</scope></search><sort><creationdate>20060301</creationdate><title>Loading dose of vancomycin in critically ill patients: 15 mg/kg is a better choice than 500 mg</title><author>Mohammedi, I. ; Descloux, E. ; Argaud, L. ; Le Scanff, J. ; Robert, D.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-e330t-ede045d48b5f41568277b549382bce577791a7c5764f07a21cee0699c5b2e39c3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2006</creationdate><topic>Aged</topic><topic>Antibiotics. Antiinfectious agents. Antiparasitic agents</topic><topic>Biological and medical sciences</topic><topic>Critical Illness</topic><topic>Dose-Response Relationship, Drug</topic><topic>Female</topic><topic>Gram-Positive Bacterial Infections - drug therapy</topic><topic>Gram-Positive Bacterial Infections - microbiology</topic><topic>Humans</topic><topic>ICU</topic><topic>Intensive Care Units</topic><topic>Loading dose</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Pharmacology. Drug treatments</topic><topic>Vancomycin</topic><topic>Vancomycin - administration & dosage</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Mohammedi, I.</creatorcontrib><creatorcontrib>Descloux, E.</creatorcontrib><creatorcontrib>Argaud, L.</creatorcontrib><creatorcontrib>Le Scanff, J.</creatorcontrib><creatorcontrib>Robert, D.</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Industrial and Applied Microbiology Abstracts (Microbiology A)</collection><collection>Technology Research Database</collection><collection>Environmental Sciences and Pollution Management</collection><collection>Engineering Research Database</collection><collection>Biotechnology and BioEngineering Abstracts</collection><jtitle>International journal of antimicrobial agents</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Mohammedi, I.</au><au>Descloux, E.</au><au>Argaud, L.</au><au>Le Scanff, J.</au><au>Robert, D.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Loading dose of vancomycin in critically ill patients: 15 mg/kg is a better choice than 500 mg</atitle><jtitle>International journal of antimicrobial agents</jtitle><addtitle>Int J Antimicrob Agents</addtitle><date>2006-03-01</date><risdate>2006</risdate><volume>27</volume><issue>3</issue><spage>259</spage><epage>262</epage><pages>259-262</pages><issn>0924-8579</issn><eissn>1872-7913</eissn><abstract>Delays in antimicrobial therapy in high-risk patients with infection may have deleterious effects on clinical outcomes. Therefore, appropriate treatment must be initiated promptly. The objective of this prospective study was to determine the better loading dose of vancomycin in critically ill patients with suspected Gram-positive infections. Two groups of patients were studied successively: Group A, loading dose of 500
mg; and Group B, loading dose of 15
mg/kg. The mean post-loading dose serum vancomycin concentration was significantly higher in Group B than in Group A (19.1
±
7.4
mg/L versus 10.4
±
2.7
mg/L;
P
<
0.001), without producing toxic peak levels. Clinical cure rates were significantly different for infected patients in Group B compared with Group A: 93% (14 of 15 patients) versus 56% (10 of 18 patients), respectively. However, the proportion of patients surviving to Intensive Care Unit discharge was similar. Because vancomycin is believed to achieve maximum killing at concentrations in serum of four to five times the minimum inhibitory concentration for the infecting organism, our results suggest that the 15
mg/kg loading dose should be preferred.</abstract><cop>London</cop><cop>Amsterdam</cop><cop>New York, NY</cop><pub>Elsevier B.V</pub><pmid>16472993</pmid><doi>10.1016/j.ijantimicag.2005.11.009</doi><tpages>4</tpages></addata></record> |
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| ispartof | International journal of antimicrobial agents, 2006-03, Vol.27 (3), p.259-262 |
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| language | eng |
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| source | MEDLINE; Elsevier ScienceDirect Journals |
| subjects | Aged Antibiotics. Antiinfectious agents. Antiparasitic agents Biological and medical sciences Critical Illness Dose-Response Relationship, Drug Female Gram-Positive Bacterial Infections - drug therapy Gram-Positive Bacterial Infections - microbiology Humans ICU Intensive Care Units Loading dose Male Medical sciences Middle Aged Pharmacology. Drug treatments Vancomycin Vancomycin - administration & dosage |
| title | Loading dose of vancomycin in critically ill patients: 15 mg/kg is a better choice than 500 mg |
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