The effect of body mass index and creatinine clearance on serum trough concentration of vancomycin in adult patients
Open Access
- 13 May 2020
- journal article
- research article
- Published by Springer Science and Business Media LLC in BMC Infectious Diseases
- Vol. 20 (1), 1-7
- https://doi.org/10.1186/s12879-020-05067-7
Abstract
The aim of this study was to evaluate the influence of patient body mass index (BMI) and estimated creatinine clearance (CrCl) on serum vancomycin concentrations to define a possible optimal dosage regimen in overweight patients based on data obtained during therapeutic drug monitoring. This retrospective study used data collected from January 2017 to January 2019. Adult patients (n = 204) received vancomycin treatment at a dose of 1000 mg every 12 h and underwent serum monitoring. Data collected included patient disease category, sex, age, height, weight, vancomycin concentrations, and serum creatinine. The CrCl values were estimated using the Cockcroft-Gault formula. In this study, statistical comparisons were performed on the results of patients according to serum vancomycin concentration. Serum vancomycin concentration was significantly related to BMI (P < 0.001) and CrCl (P < 0.05) in adult patients. Furthermore, the trough serum vancomycin concentration showed a logarithmic correlation with BMI (R = − 0.5108, 95% CI: − 0.6082 to − 0.3982, P < 0.001) and CrCl (R = − 0.5739, 95% CI: − 0.6616 to − 0.4707, P < 0.001). The multivariate analysis showed that BMI and CrCl are independent contributors to the trough vancomycin concentration. Moreover, some of the patients with higher BMI (≥ 24 kg/m2) met the goal trough concentration after an adjustment from 1000 mg every 12 h to 1000 mg every 8 h. Serum vancomycin concentration decreases progressively with increasing BMI and the augmentation in CrCl in adult patients. The trough concentration of vancomycin should be continuously monitored for patients with a BMI ≥ 24 kg/m2, and the dosage regimen should be adjusted to reach the target trough concentration in these patients to reduce the impact of BMI.Keywords
Other Versions
Funding Information
- Young Scientists Fund (81703532, 81902320, 81701490)
This publication has 27 references indexed in Scilit:
- Clinical Practice Guidelines by the Infectious Diseases Society of America for the Treatment of Methicillin-Resistant Staphylococcus aureus Infections in Adults and Children: Executive SummaryClinical Infectious Diseases, 2011
- Clinical Practice Guidelines by the Infectious Diseases Society of America for the Treatment of Methicillin-Resistant Staphylococcus aureus Infections in Adults and ChildrenClinical Infectious Diseases, 2011
- Effect of Obesity on the Pharmacokinetics of Drugs in HumansClinical Pharmacokinetics, 2010
- Body Mass Index Is Associated with Increased Creatinine Clearance by a Mechanism Independent of Body Fat DistributionJournal of Clinical Endocrinology & Metabolism, 2009
- Vancomycin Therapeutic Guidelines: A Summary of Consensus Recommendations from the Infectious Diseases Society of America, the American Society of Health-System Pharmacists, and the Society of Infectious Diseases PharmacistsClinical Infectious Diseases, 2009
- Therapeutic monitoring of vancomycin in adult patients: A consensus review of the American Society of Health-System Pharmacists, the Infectious Diseases Society of America, and the Society of Infectious Diseases PharmacistsAmerican Journal of Health-System Pharmacy, 2009
- Larger Vancomycin Doses (at Least Four Grams per Day) Are Associated with an Increased Incidence of NephrotoxicityAntimicrobial Agents and Chemotherapy, 2008
- Population Pharmacokinetics of Arbekacin in Patients Infected with Methicillin-Resistant Staphylococcus aureusAntimicrobial Agents and Chemotherapy, 2006
- ForewordAmerican Journal of Kidney Diseases, 2001
- Prediction of Creatinine Clearance from Serum CreatinineNephron, 1976