Continuous Infusion Dosage Regimen of Vancomycin for Empirical Treatment Among Critically Ill Thai Population in the Era “MIC Creep” Methicillin-Resistant Staphylococcus aureus

Setiawan, Eko (2016) Continuous Infusion Dosage Regimen of Vancomycin for Empirical Treatment Among Critically Ill Thai Population in the Era “MIC Creep” Methicillin-Resistant Staphylococcus aureus. In: World Congress of Internal Medicine (WCIM) 2016, Bali, 22-25 Agustus 2016, Bali Indonesia.

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Abstract

Background Owing to the “MIC Creep” phenomenon of MRSA Strain and the achievement of AUC0-24/MIC as the the most desirable PK-PD target for vancomycin treatment, continuous infusion dosage regimen of vancomycin may play an important role to ensure the efficacy of the treatment. The objective of present study was to determine the most intended empirical dosage regimen of vancomycin continuous infusion (CoI) for critically ill Thai population in the era of “MIC Creep” of MRSA. Method Monte Carlo Simulation with 10,000 replication was conducted to identify the achievement of Cumulative Fraction of Response (CFR) for several CoI vacomycin without loading dose (LD) ranging from 2g-4g every 24 hours against MRSA with MIC ranging from 0,5-2g/L. The CFR was calculated by multiplying the percentage of probability of target attainment (PTA) in each regimen dosage of CoI vancomycin with the fraction of bacteria in the MIC distribution derived from EUCAST database. The percentage of PTA was claculated by dividing the number of achievement AUC0-24/MIC ≥400 mg.hr/L for each dosage regimen against certain defined MIC of MRSA with total 10,000 simulated critically ill population and then multipying with 100%. Calculation of plasma concentration in each certain time of drug determined by population pharmacokinetic model conducted in Thai critically ill population. Results There were 0.24%, 60.35%, 39.11%, 0.30% of MRSA strain with MIC 0.5, 1.0, 1.5, 2.0g/L in EUCAST database, respectively. Continuous dosage regimens 2 g/day and 4 g/day afforded the lowest and highest percentage of CFR for the whole MRSA strain regardless the MIC value, i.e: 48.339% and 91.761%, respectively. While, continuous dosage regimen 3 g/day afforded CFR 70.821%. Conclusion Standard dose of vancomycin, i.e 2g/day, should not be used as an empirical in the setting where most identified MRSA strains have MIC 0.5g/L. Present study recommended the best CoI dosage regimen to achieve intended CFR value (>80%) in the era of “MIC Creep” phenomenon was 4g/day. Further study exploring the LD needed and risk of nephrotoxicity afforded by each dosage regimen was needed in order to optimise the efficacy and safety profile of CoI vancomycin.

Item Type: Conference or Workshop Item (Poster)
Subjects: R Medicine > RS Pharmacy and materia medica
Divisions: Faculty of Pharmacy > Department of Pharmacy
Depositing User: Eko Setiawan 206023
Date Deposited: 27 Feb 2017 04:51
Last Modified: 27 Feb 2017 08:28
URI: http://repository.ubaya.ac.id/id/eprint/28983

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