Program Schedule

193
Impact of Weight Based Dosing Guidelines on Vancomycin Dosing and Trough Levels Including in Obese Patients

Session: Poster Abstract Session: Antibiotic Stewardship
Thursday, October 9, 2014
Room: The Pennsylvania Convention Center: IDExpo Hall BC
Posters
  • idweek poster.pdf (589.7 kB)
  • Background: In 2009, the American Society of Health System Pharmacists, Infectious Diseases Society of America, Society of the Infectious Diseases  Pharmacists released guidelines on vancomycin. Applying guidelines to a local population, particularly obese patients, has not been well-studied.

    Methods:  A retrospective review was done on patients at an acute care, university-affiliated, community hospital who received intravenous vancomycin for suspected/documented infections before and after implementing the 2009 guidelines. Before 2009, patient received vancomycin, 1 gm every 12 hrs. After the guidelines, patients were dosed on actual body weight (ABW), 15-20mg/kg, or 25-30mg/kg in seriously ill patients, every 8-12 hrs. We compared the frequency of therapeutic troughs, nephrotoxicity and trough group levels stratified by Body Mass Index (BMI).

    Results: There were no significant differences in therapeutic troughs and nephrotoxicity. Adjusted for BMI, there was a significant difference in trough levels between the two groups, p=0.0109. However, a large number of patients in the conventionally-dosed group were excluded due to inconsistent doses. In the ABW-dosed group, there was a high number of high trough levels in 48% of patients with BMIs >35, p=0.005

    Conclusion: Obese patients may require an alternate dosing strategy as the ABW-dosing based on the 2009 national guidelines resulted in supra-therapeutic levels in patients with high BMIs. Implementing guidelines-based monitoring resulted in more consistent and appropriately drawn trough levels.                                                                                                                                                                                                   

                                                                                                                                                                                            

     

     

    Conclusions: Obese patients may require an alternate dosing strategy as the ABW dosing based on the 2009 national guidelines resulted in supra-therapeutic levels in patients with high BMIs. Implementing guidelines-based monitoring resulted in more consistently and appropriately drawn trough levels.

     

     

     

    Erlaine F. Bello, M.D.1,2, Koh Okamoto, M.D.3, James Davis, PhD4, Lois Dement, PharmD2 and Teppei Shimasaki, M.D.1, (1)Dept of Medicine, John A Burns School of Medicine, University of Hawaii, Honolulu, HI, (2)The Queen's Medical Center, Honolulu, HI, (3)Medicine, Rush University, Oak Park, IL, (4)Complemetary and Alternative Medicine, John A Burns School of Medicine, University of Hawaii, Honolulu, HI

    Disclosures:

    E. F. Bello, None

    K. Okamoto, None

    J. Davis, None

    L. Dement, None

    T. Shimasaki, None

    Findings in the abstracts are embargoed until 12:01 a.m. EDT, Oct. 8th with the exception of research findings presented at the IDWeek press conferences.

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