Vancomycin Pharmacokinetic Parameters in Patients Undergoing Hematopoietic Stem Cell Transplantation (HSCT)

Background: Vancomycin is used abundantly in patients undergoing HSCT, especially during neutropenic fever. Despite its widespread use little is known about vancomycin pharmacokinetics in HSCT patients. We conducted this study to investigate vancomycin pharmacokinetic parameters in our HSCT patient...

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Main Authors: Maryam Taghizadeh Ghehi, Saeed Rezaee, Alireza Hayatshahi, Molouk Hadjibabaie, Kheirollah Gholami, Mohammadreza Javadi, Seyed Hamid Khoee, Mania Radfar, Mohsen Esfandbod, Ardeshir Ghavamzadeh
Format: Article
Language:English
Published: Tehran University of Medical Sciences 2013-12-01
Series:International Journal of Hematology-Oncology and Stem Cell Research
Subjects:
Online Access:https://ijhoscr.tums.ac.ir/index.php/ijhoscr/article/view/443
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spelling doaj-97159107e16b4784a44dda9f281e79952020-11-25T04:02:15ZengTehran University of Medical SciencesInternational Journal of Hematology-Oncology and Stem Cell Research2008-22072013-12-0174429Vancomycin Pharmacokinetic Parameters in Patients Undergoing Hematopoietic Stem Cell Transplantation (HSCT)Maryam Taghizadeh Ghehi0Saeed Rezaee1Alireza Hayatshahi2Molouk Hadjibabaie3Kheirollah Gholami4Mohammadreza Javadi5Seyed Hamid Khoee6Mania Radfar7Mohsen Esfandbod8Ardeshir Ghavamzadeh9Research Center for Rational Use of Drugs, Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.Department of Pharmaceutics, Faculty of Pharmacy, Ahvaz University of Medical Sciences, Ahvaz, Iran.Clinical Pharmacy Department, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.Research Center for Rational Use of Drugs, Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.Research Center for Rational Use of Drugs, Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.Research Center for Rational Use of Drugs, Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.Clinical Pharmacy Department, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.Clinical Pharmacy Department, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.Hematology-Oncology and SCT Research Centre, Department of Hematology-Oncology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.Hematology-Oncology and SCT Research Centre, Department of Hematology-Oncology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran. Background: Vancomycin is used abundantly in patients undergoing HSCT, especially during neutropenic fever. Despite its widespread use little is known about vancomycin pharmacokinetics in HSCT patients. We conducted this study to investigate vancomycin pharmacokinetic parameters in our HSCT patients and to evaluate current dosing regimen based on trough vancomycin concentrations measurement. Methods: Vancomycin serum concentration at steady-state was determined prospectively in 46 adult HSCT patients who received vancomycin as empirical treatment of neutropenic fever. Individual steady-steady pharmacokinetic parameters were also determined in 20 patients who had two vancomycin levels from an administered dose, assuming one-compartment model. Acute kidney injury was also evaluated in our patients during vancomycin therapy. Results: Mean (±SD) apparent volume of distribution (L/kg) and clearance (mL/min) were 0.6 (± 0.33) and 109.7 (± 57.5) respectively. With mean (±SD) total daily dose of vancomycin 31.9 (±10.5) mg/kg/day that was administered, more than 90 % of measured vancomycin trough concentrations were outside the range of 15-20 mg/L and 54.3% of patients had trough concentrations below 10 mg/L. Of 46 patients, 21 patients (45.7%) developed acute kidney injury (AKI) during vancomycin therapy; among them 19 patients were receiving nephrotoxic drug(s) concomitantly. Conclusion: Current vancomycin dosage regimen could not lead to recommended therapeutic serum concentrations in our patients. Large variation in vancomycin pharmacokinetic parameters observed among patients of this study along with difference of vancomycin pharmacokinetics in our study and other similar studies further explain the need for therapeutic drug monitoring and individualization of vancomycin dosing. https://ijhoscr.tums.ac.ir/index.php/ijhoscr/article/view/443Hematopoietic stem cell transplantationNeutropenic feverPharmacokinetic parametersVancomycin
collection DOAJ
language English
format Article
sources DOAJ
author Maryam Taghizadeh Ghehi
Saeed Rezaee
Alireza Hayatshahi
Molouk Hadjibabaie
Kheirollah Gholami
Mohammadreza Javadi
Seyed Hamid Khoee
Mania Radfar
Mohsen Esfandbod
Ardeshir Ghavamzadeh
spellingShingle Maryam Taghizadeh Ghehi
Saeed Rezaee
Alireza Hayatshahi
Molouk Hadjibabaie
Kheirollah Gholami
Mohammadreza Javadi
Seyed Hamid Khoee
Mania Radfar
Mohsen Esfandbod
Ardeshir Ghavamzadeh
Vancomycin Pharmacokinetic Parameters in Patients Undergoing Hematopoietic Stem Cell Transplantation (HSCT)
International Journal of Hematology-Oncology and Stem Cell Research
Hematopoietic stem cell transplantation
Neutropenic fever
Pharmacokinetic parameters
Vancomycin
author_facet Maryam Taghizadeh Ghehi
Saeed Rezaee
Alireza Hayatshahi
Molouk Hadjibabaie
Kheirollah Gholami
Mohammadreza Javadi
Seyed Hamid Khoee
Mania Radfar
Mohsen Esfandbod
Ardeshir Ghavamzadeh
author_sort Maryam Taghizadeh Ghehi
title Vancomycin Pharmacokinetic Parameters in Patients Undergoing Hematopoietic Stem Cell Transplantation (HSCT)
title_short Vancomycin Pharmacokinetic Parameters in Patients Undergoing Hematopoietic Stem Cell Transplantation (HSCT)
title_full Vancomycin Pharmacokinetic Parameters in Patients Undergoing Hematopoietic Stem Cell Transplantation (HSCT)
title_fullStr Vancomycin Pharmacokinetic Parameters in Patients Undergoing Hematopoietic Stem Cell Transplantation (HSCT)
title_full_unstemmed Vancomycin Pharmacokinetic Parameters in Patients Undergoing Hematopoietic Stem Cell Transplantation (HSCT)
title_sort vancomycin pharmacokinetic parameters in patients undergoing hematopoietic stem cell transplantation (hsct)
publisher Tehran University of Medical Sciences
series International Journal of Hematology-Oncology and Stem Cell Research
issn 2008-2207
publishDate 2013-12-01
description Background: Vancomycin is used abundantly in patients undergoing HSCT, especially during neutropenic fever. Despite its widespread use little is known about vancomycin pharmacokinetics in HSCT patients. We conducted this study to investigate vancomycin pharmacokinetic parameters in our HSCT patients and to evaluate current dosing regimen based on trough vancomycin concentrations measurement. Methods: Vancomycin serum concentration at steady-state was determined prospectively in 46 adult HSCT patients who received vancomycin as empirical treatment of neutropenic fever. Individual steady-steady pharmacokinetic parameters were also determined in 20 patients who had two vancomycin levels from an administered dose, assuming one-compartment model. Acute kidney injury was also evaluated in our patients during vancomycin therapy. Results: Mean (±SD) apparent volume of distribution (L/kg) and clearance (mL/min) were 0.6 (± 0.33) and 109.7 (± 57.5) respectively. With mean (±SD) total daily dose of vancomycin 31.9 (±10.5) mg/kg/day that was administered, more than 90 % of measured vancomycin trough concentrations were outside the range of 15-20 mg/L and 54.3% of patients had trough concentrations below 10 mg/L. Of 46 patients, 21 patients (45.7%) developed acute kidney injury (AKI) during vancomycin therapy; among them 19 patients were receiving nephrotoxic drug(s) concomitantly. Conclusion: Current vancomycin dosage regimen could not lead to recommended therapeutic serum concentrations in our patients. Large variation in vancomycin pharmacokinetic parameters observed among patients of this study along with difference of vancomycin pharmacokinetics in our study and other similar studies further explain the need for therapeutic drug monitoring and individualization of vancomycin dosing.
topic Hematopoietic stem cell transplantation
Neutropenic fever
Pharmacokinetic parameters
Vancomycin
url https://ijhoscr.tums.ac.ir/index.php/ijhoscr/article/view/443
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