G. Gonzalezmartin et al., PHARMACOKINETICS OF VANCOMYCIN IN PATIENTS WITH SEVERELY IMPAIRED RENAL-FUNCTION, International journal of clinical pharmacology and therapeutics, 34(2), 1996, pp. 71-75
The pharmacokinetics of 1 g dose of intravenous vancomycin was studied
in 8 patients with severe renal failure. Serum vancomycin levels were
determined by fluorescence polarization immunoassay. After single dos
e of vancomycin peak concentrations ranged from 37.8 mu g.ml(-1) to 10
9.3 mu g. ml(-1) (mean 64.9 +/- 21.7 mu g.ml(-1)). Vancomycin trough c
oncentration 168h after administration of the antibiotic ranged from 2
.23 mu g.ml(-1) to 11.42 mu g.ml(-1) (mean 6.55 +/- 2.8 mu g.ml(-1)).
The data were analyzed using a PCNONLINE computer program, and in all
patients a triexponential model described how concentrations decreased
in time. Three-compartment parameters obtained from the 8 patients we
re t(1/2) alpha = 0.312 +/- 0.242 h, t(1/2) beta 6.012 +/- 5.36 h, and
t(1/2) gamma = 131.0 +/- 46.7 h. Vd = 0.158 +/- 0.121 1.kg(-1), Vdss
= 0.920 +/- 0.248 1.kg(-1) and total Cl = 0.10 +/- 0.049 1.h(-1) per k
g of weight. Between 1.5% and 21.2% of the administered vancomycin dos
e was eliminated during hemodialysis. The dialysis clearance of vancom
ycin ranged from 50.6 ml.min(-1) to 76.8 ml.min(-1) (average: 62.4 +/-
10.4 ml.min(-1)). However, after dialysis plasma concentrations retur
ned to pre-dialysis values. In accordance to our kinetic study 1 g of
vancomycin given every 7 days is adequate treatment for methicillin-re
sistant Staphylococcus aureus infections in patients with severe renal
failure whose creatinine clearance is lower than 10 ml.min(-1).