Table 1.
Studies with Clinical Audit of Vancomycin Dosing
| Author (Year) | Country | Study Design | Characteristics of Patients Included | Patients with Neutropenia (%) | Sample Size | Age (Years) | Gender (M/F) | Weight (kg) | Renal Function | Vancomycin Dosing Regimen | Timing of Serum Vancomycin | Summary of Results |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Hochart 201121 | France | Single-center retrospective study | Acute myeloid leukemia patients with febrile neutropenia | 100% | 54 (67 vancomycin treatment courses, VTCs) | 50 ± 13.6 | 27/27 | 73 ± 18.1 | 107.5 ± 35.4 mL/min | Continuous infusion; loading dose: 15.5 ± 3.3 mg/kg; maintenance dose: 35.4 ± 6.9 mg/kg/d |
At 24 hours for patients with a loading dose and 48 hours for patients without any loading dose. | ▪ the target serum level for continuous infusion was greater than 20 mg/L, and only 6 (12%) cases achieved the target |
| O’Donnell 201116 (conference abstract) | UK | Single-center retrospective study | Bone marrow transplant patients who experienced an episode of febrile neutropenia | 100% | 12 | NR | NR | NR | NR | NR | At 24 hours, then twice weekly. | ▪ 32% of trough levels were subtherapeutic (< 5 mg/L). |
| Donovan 201218 (conference abstract) | United states | Retrospective study | Neutropenic adult patients | 100% | 198 | NR | NR | NR | NR | Intermittent infusion; 15 – 20 mg/kg/dose and administration times are determined by renal function | NR | ▪ 25.3% of patients achieved therapeutic trough concentrations (15 – 20 mg/L) |
| Vazin 201222 | Iran | Prospective study | Patients in a hematology-oncology ward who received at least 3 successive doses of vancomycin and had serum vancomycin concentrations at steady state | 88% | 58 | 36.58 ± 14.33 | 44/14 | 68.05 ± 12.61 | 57/58 (98.2%) a | Intermittent infusion; Correcting dosage based on creatinine clearance was given to 10 (17.23%) of the patients |
Blood samples were taken from the patients who received vancomycin for 3 consecutive days, and just before the administration of the next dose. | ▪ vancomycin trough serum concentration range was 15.59 ± 13.02 mg/L ▪ subtherapeutic trough level (< 10 mg/L) was detected in 3.6% of patients ▪ 53.3% had a level above the maximum therapeutic concentration |
| Ghehi 201320 | Iran | Single-center prospective study | Adults receiving vancomycin for neutropenic fever after HSCT | 100% | 46 | 32.9 ± 12.45 | 30/16 | 74.8 ± 16.6 | 102.5 ± 35.33 mL/min | Intermittent infusion; 31.9 (±10.5) mg/kg/d | Within 30 minutes prior to the fourth dose | ▪ 25 (54.3%) patients had trough concentrations of <10 mg/L ▪ 6 patients (13%) had trough levels of < 5 mg/L |
| Luo 201417 | Canada | Single-center prospective study | Leukemia/bone marrow transplant outpatients (at least two doses of vancomycin) | 42% | 48 | 54.5b | 24/24 | NR | 77 μmol/Lb | Intermittent infusion; once-daily (2073 ± 338 mg/d) |
NR | ▪ 10 (21%) patients had therapeutic vancomycin trough concentrations (i.e., greater than 10 mg/L) |
| Vermis 201419 (conference abstract) |
Belgium | Single-center retrospective study | Patients with hematologic malignancies | 72% | 96 (112 VTCs) | NR | NR | NR | NR | Continuous infusion; loading dose: 15 mg/kg, maintenance dose: 30 mg/kg/d |
NR | ▪ ARCc was observed in 73 VTC with an average renal clearance of 147.0 mL/min versus 79.0 mL/min. ▪ Therapeutic vancomycin levels (20 mg/L) were obtained on day 5 (median) with an average vancomycin maintenance dose of 41.7 mg/kg/day when ARC was present versus 32.7 mg/kg/day on day 3. |
Notes: aProportion of patients with normal renal function; bmedian; cARC was defined as calculated creatinine clearance exceeding 120 mL/min (Cockcroft–Gault formula).
Abbreviations: NR, not reported; HSCT, hematopoietic stem cell transplantation; VTC, vancomycin treatment course; ARC, augmented renal clearance.