Vancomycin Dosing Regimen by Monte Carlo Simulation in Patients on Intermittent High-Efficiency Hemodialysis (HEHD)
Daraporn Rungprai B Pharm*,**, Sutep Jaruratanasirikul MD***, Wibul Wongpoowarak MSc****, Sutthiporn Pattharachayakul Pharm D, BCPS*, Usanee Wanakamanee MSc, BCP*, Phongsak Dandecha MD***, Arnurai Jitsurong MSc*****
Affiliation : * Department of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, Prince of Songkla University, Hat Yai, Songkhla, Thailand ** The College of Pharmacotherapy of Thailand, The Pharmacy Council of Thailand, Bangkok, Thailand *** Department of Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand **** Department of Pharmaceutical Technology, Faculty of Pharmaceutical Sciences, Prince of Songkla University, Hat Yai, Songkhla, Thailand ***** Department of Pathology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
Objective : To evaluate the effective vancomycin dosing regimens by Monte Carlo simulation among patients on intermittent
high-efficiency hemodialysis (HEHD).
Material and Method: The present study was conducted on eight end-stage renal disease patients receiving HEHD. The
patients received an initial dose of vancomycin 1 g followed by 500 mg immediately after HEHD session for a supplementation.
Blood samplings were obtained to investigate vancomycin pharmacokinetic parameters. A Monte Carlo simulation was
performed to determine the percentage of probability of target attainment (PTA) achieving AUC24/MIC ratio greater than
or equal to 400 as the target of achievement of antimicrobial activity.
Results : A loading dose (LD) of vancomycin of 20 mg per kilogram of dry weight (DW) with or without a supplementation
had the optimum effectiveness for pathogens with MICs not greater than 0.5 mg/L. For pathogens with an MIC of 1.0 mg/L,
the LD of 25 mg/kgDW followed by 20 or 25 mg/kgDW supplementation was achieved the target in some cases. Therefore,
the LD of 30 mg/kgDW followed by 25 mg/kgDW or the LD of 35 mg/kgDW with 10, 20 or 25 mg/kgDW supplementation
was required to achieve the target of antimicrobial activity.
Conclusion : From the present study, the lowest vancomycin dosing regimen that had the optimum effectiveness was a
35 mg/kgDW LD followed by 10 mg/kgDW supplementation. This regimen is recommended to treat pathogens with MICs
not greater than 1.0 mg/L.
Keywords : Vancomycin, Dosing regimen, Monte Carlo simulation, High-efficiency hemodialysis (HEHD)
