PULMONARY DISPOSITION OF VANCOMYCIN IN CRITICALLY ILL PATIENTS

Vancomycin penetration in epithelium lining fluid was studied in ten m echanically ventilated patients with methicillin-resistant Staphylococ cus aureus pneumonia 24 hours after the onset of treatment. Vancomycin was given intravenously at a daily dose of 30 mg/kg. Vancomycin level s were detectable in four patients (range, 1-2.77 mu g/ml). Concordanc e between high plasma concentrations (>20 mu g/ml) and detectable vanc omycin levels in epithelium lining fluid was noted. These results sugg est that the pulmonary disposition of vancomycin remains low for most patients 24 h after the onset of treatment compared with the minimum i nhibitory concentrations for most gram-positive organisms. One therape utic goal of vancomycin treatment could be to obtain through plasma le vels of 20 mu g/ml. Further studies are required to determine the clin ical relevance of these observations.