• Weerachai Chaijamorn, Arnurai Jitsurong, Kamonthip Wiwattanawongsa, Usanee Wanakamanee, and Phongsak Dandecha.
• Faculty of Pharmacy, Siam University, Bangkok 10160, Thailand. zernpharm@yahoo.com
• Int. J. Antimicrob. Agents. 2011 Aug 1; 38 (2): 152-6.

AbstractThe objective of this study was to determine the pharmacokinetics and dosing recommendations of vancomycin in critically ill patients receiving continuous venovenous haemofiltration (CVVH). A prospective study was conducted in the Intensive Care Unit of a university hospital. Seven patients receiving CVVH with a triacetate hollow-fibre dialyser were enrolled. CVVH was performed in pre-dilution mode with a blood flow rate of 200-250 mL/min and an ultrafiltrate flow rate of 800-1200 mL/h. To determine vancomycin pharmacokinetics, serum and ultrafiltrate were collected over 12 h after a 2-h infusion of 1000 mg vancomycin. The mean (± standard deviation) sieving coefficient of vancomycin was 0.71±0.13, which is consistent with previously reported values. Clearance of vancomycin by CVVH (0.73±0.21 L/h or 12.11±3.50 mL/min) constituted 49.4±20.8% of total vancomycin clearance (1.59±0.47 L/h) and was consistent with previously reported clearances. Approximately one-fifth of the vancomycin dose was removed during the 12-h CVVH (213.9±104.0 mg). The volume of distribution was 24.69±11.00 L, which is smaller than previously reported. The elimination rate constant and terminal half-life were 0.08±0.05 h(-1) and 12.02±7.00 h, respectively. In conclusion, elimination of vancomycin by CVVH contributed to ca. 50% of the total elimination in critically ill patients. The maintenance dose of vancomycin, calculated from parameters from patients in this study, would be 500-750 mg every 12 h to provide a steady-state trough concentration of 15-20 mg/L. Owing to alterations in clinical conditions, serum vancomycin concentrations must be closely monitored in critically ill patients.Copyright © 2011 Elsevier B.V. and the International Society of Chemotherapy. All rights reserved.

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