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The pharmacokinetics of vancomycin during the initial loading dose in patients with septic shock

Authors Katip W, Jaruratanasirikul S, Pattharachayakul S, Wongpoowarak W, Jitsurong A, Lucksiri A

Received 4 September 2016

Accepted for publication 26 October 2016

Published 22 November 2016 Volume 2016:9 Pages 253—260

DOI https://doi.org/10.2147/IDR.S121513

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Akshita Wason

Peer reviewer comments 2

Editor who approved publication: Professor Suresh Antony

Wasan Katip,1 Sutep Jaruratanasirikul,2 Sutthiporn Pattharachayakul,3 Wibul Wongpoowarak,4 Arnurai Jitsurong,5 Aroonrut Lucksiri1

1Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, 2Department of Medicine, Faculty of Medicine, 3Department of Clinical Pharmacy, 4Department of Pharmaceutical Technology, Faculty of Pharmaceutical Sciences, 5Department of Toxicology, Faculty of Medicine, Prince of Songkla University, Songkla, Thailand

Objective: To characterize the pharmacokinetics (PK) of vancomycin in patients in the initial phase of septic shock.
Methods: Twelve patients with septic shock received an intravenous infusion of vancomycin 30 mg/kg over 2 h. The vancomycin PK study was conducted during the first 12 h of the regimen. Serum vancomycin concentration–time data were analyzed using the standard model-independent analysis and the compartment model.
Results: For the noncompartment analysis the mean values ± standard deviation (SD) of the estimated clearance and volume of distribution of vancomycin at steady state were 6.05±1.06 L/h and 78.73±21.78 L, respectively. For the compartmental analysis, the majority of vancomycin concentration–time profiles were best described by a two-compartment PK model. Thus, the two-compartmental first-order elimination model was used for the analysis. The mean ± SD of the total clearance (3.70±1.25 L/h) of vancomycin was higher than that obtained from patients without septic shock. In contrast, the volume of the central compartment (8.34±4.36 L) and volume of peripheral compartment (30.99±7.84 L) did not increase when compared with patients without septic shock.
Conclusion: The total clearance of vancomycin was increased in septic shock patients. However, the volume of the central compartment and peripheral compartment did not increase. Consequently, a loading dose of vancomycin should be considered in all patients with septic shock.

Keywords: pharmacokinetics, vancomycin, MRSA, septic shock patients

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