Pharmacokinetic and Pharmacodynamic Approach in Adult Critically-Ill Patients Treated with Standard Dose of Vancomycin for MRSA Infection
Eko Setiawan SFarm, MSc, Apt1, Preecha Montakantikul PharmD, BCP2
Affiliation : 1 Center for Medicine Information and Pharmaceutical Care, Faculty of Pharmacy, University of Surabaya, Indonesia 2 Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand
Background : The achievement of vancomycin’s pharmacokinetic/pharmacodynamic [PK/PD] index, i.e., AUC24/MIC 400 mg-hour/L
or more, is highly determined by pharmacokinetic parameters of different groups of patients.
Objective : To investigate the possibility of standard dose of vancomycin to achieve AUC24/MIC of 400 mg-hour/L or more in
critically-ill adult patients.
Materials and Methods : The literature search was conducted in PubMed, Cochrane, and Trip Database from database inception
until August 2012 by using MeSH term and combination of several keywords. Studies included in the present review should present
population pharmacokinetic equation model. Further analysis would consider mean, minimum, and maximum values of covariates
that in(cid:976)luenced the pharmacokinetic equation models. The maximum MIC was chosen to be 2 mg/L according to susceptibility
breakpoint of Staphylococcus aureus to vancomycin.
Results : Four studies were included in the present study. The range of volume distribution, clearance, AUC24, and MIC coverage
calculated by using mean value of in(cid:976)luential covariates of pharmacokinetic equation model were 59.86 to 149.05 L, 3.03 to 4.15
L/hour, 481.46 to 661.09 mg-hour/L, and 1.20 to 1.65 mg/L, respectively. The minimum and maximum values of in(cid:976)luential
covariates gave the following results, 36.90 to 306.27 L, 0.18 to 13.22 L/hour, 151.34 to 10,917.03 mg-hour/L, and 0.38 to 27.29
mg/L, respectively.
Conclusion : Not all critically-ill patients infected with vancomycin-susceptible MRSA were effectively treated by standard dose of
vancomycin. Drug concentration monitoring and MRSA’s MIC testing are needed to be regularly conducted to ensure the effectiveness
of vancomycin treatment.
Keywords : Vancomycin, Critically ill, Methicillin-resistant Staphylococcus aureus
