Vancomycin Dose Optimization of the Patients with Septic Shock in Chonburi Hospital

Abstract

Vancomycin's pharmacokinetic characteristics changed in septic shock patients, resulting in physiological changes, caused high serum drug concentration that led to toxicity or a subtherapeutic dose of the drug to reach the therapeutic target of infection. Optimizing the dosage of vancomycin improves effectiveness and reduces side effects. The aim of our study was to determine to optimize vancomycin dose in septic shock in Chonburi hospital. Serum vancomycin samples from septic shock patients hospitalized to Chonburi Hospital between January 1, 2019, and July 31, 2023, were gathered prospectively and retrospectively. Eighty-eight vancomycin-treated septic shock patients were included and 174 vancomycin concentrations were obtained. The mean (SD) age was 58 (17) years and median creatinine clearance (IQR) was 44.27 (24.00 – 75.28) ml/min. Pharmacokinetic parameters of vancomycin was simulated from vancomycin concentration of each patient. Mean (SD) volume of distribution was 0.80 (0.17) liter per kilogram and median vancomycin clearance was (IQR) 1.39 (0.96 – 3.68) liter per hour, vancomycin dosing was simulated stratified by creatinine clearance to target vancomycin pharmacokinetic with AUC₂₄/MIC 400 – 600 mg·hr/L. According to pharmaceutical database, vancomycin dosing classified by renal function was dissimilar to simulated dose in these septic shock patients especially in moderate to severe renal function (CrCl < 50 ml/min). Therapeutic drug monitor of vancomycin altogether with this recommended dose for septic shock patients would improve efficacy and safety.