Ajustement de la posologie de la vancomycine administrée en perfusion continue chez des patients de réanimation

Abstract

IntroductionAs the susceptibility of staphylococcal strains to glycopeptides rises, it is becoming necessary to increase vancomycin dosages. ObjectiveTo evaluate an administration protocol for vancomycin using continuous infusion with a loading dose of 30mg/kg followed by 30mg/kg per 24h in intensive care patients presenting creatinine clearance (CLc) greater than 50. ResultsA total of 22 patients were included in the study. Serum vancomycin concentrations after 24h (C24h) ranged from 25 to 30mg/l in seven of 14 patients with CLc less than 120ml/min (50 %), compared with three patients (21 %) with C24h greater than 35mg/l and four patients (29 %) with C24h less than 25 mg/l. However, C24h was less than 20mg/l for the eight patients with CLc greater or equal to 120ml/min. Bacteriological data was available for eight of the 14 patients with CLc less than 120ml/min, and in these eight patients, the C24h/MIC was greater or equal to 8; seven of these patients had an AUC/MIC greater or equal to 350. ConclusionAssay of serum vancomycin concentrations after 24h of treatment is necessary to enable rapid adjustment of vancomycin concentration in order to improve therapeutic efficacy or avoid nephrotoxicity.