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      Therapeutic monitoring of vancomycin for serious methicillin-resistant Staphylococcus aureus infections: A revised consensus guideline and review by the American Society of Health-System Pharmacists, the Infectious Diseases Society of America, the Pediatric Infectious Diseases Society, and the Society of Infectious Diseases Pharmacists

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          Prediction of Creatinine Clearance from Serum Creatinine

          A formula has been developed to predict creatinine clearance (C cr ) from serum creatinine (S cr ) in adult males: Ccr = (140 – age) (wt kg)/72 × S cr (mg/100ml) (15% less in females). Derivation included the relationship found between age and 24-hour creatinine excretion/kg in 249 patients aged 18–92. Values for C cr were predicted by this formula and four other methods and the results compared with the means of two 24-hour C cr’s measured in 236 patients. The above formula gave a correlation coefficient between predicted and mean measured Ccr·s of 0.83; on average, the difference between predicted and mean measured values was no greater than that between paired clearances. Factors for age and body weight must be included for reasonable prediction.
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            Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults: executive summary. Expert Panel on the Identification, Evaluation, and Treatment of Overweight in Adults.

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              High-dose vancomycin therapy for methicillin-resistant Staphylococcus aureus infections: efficacy and toxicity.

              Vancomycin hydrochloride treatment failure for infections caused by susceptible methicillin-resistant Staphylococcus aureus (MRSA) strains with high minimum inhibitory concentration (MIC) has prompted recent guidelines to recommend a higher vancomycin target trough of 15 to 20 microg/mL. A prospective cohort study of adult patients infected with MRSA was performed to determine the distribution of vancomycin MIC and treatment outcomes with vancomycin doses targeting an unbound trough of at least 4 times the MIC. The microbiology laboratory computer records were used to identify all patients from whom MRSA was isolated from August 1, 2004, through June 30, 2005. Primary outcome measures were clinical response, mortality, and nephrotoxicity. Patients were placed into subgroups based on target trough attainment and high vs low vancomycin MIC (>/=2 vs /=15 vs <15 microg/mL) for nephrotoxicity analyses. Of the 95 patients in the study, 51 (54%) were infected with high-MIC strains and had pneumonia (77%) and/or bacteremia. An initial response rate of 74% was achieved if the target trough was attained irrespective of MIC. However, despite achieving the target trough, the high-MIC group had lower end-of-treatment responses (24/39 [62%] vs 34/40 [85%]; P = .02) and higher infection-related mortality (11/51 [24%] vs 4/44 [10%]; P=.16) compared with the low-MIC group. High MIC (P = .03) and Acute Physiology and Chronic Health Evaluation II score (P = .009) were independent predictors of poor response in multivariate analysis. Nephrotoxicity occurred only in the high-trough group (11/63 [12%]), significantly predicted by concomitant therapy with other nephrotoxic agents. High prevalence of clinical MRSA strains with elevated vancomycin MIC (2 microg/mL) requires aggressive empirical vancomycin dosing to achieve a trough greater than 15 microg/mL. Combination or alternative therapy should be considered for invasive infections caused by these strains.

                Author and article information

                American Journal of Health-System Pharmacy
                Oxford University Press (OUP)
                March 19 2020
                March 19 2020
                [1 ]Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy & Health Sciences, Wayne State University, Detroit, MI
                [2 ]School of Medicine, Wayne State University, Detroit, MI
                [3 ]Detroit Receiving Hospital, Detroit, MI
                [4 ]Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, La Jolla, CA
                [5 ]Albany College of Pharmacy and Health Sciences, Albany, NY, and Albany Medical Center Hospital, Albany, NY
                [6 ]Department of Pediatrics, Division of Infectious Diseases, University of California at San Diego, La Jolla, CA
                [7 ]Rady Children’s Hospital San Diego, San Diego, CA
                [8 ]Division of Allergy and Infectious Diseases, University of Washington, Seattle, WA
                [9 ]Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA
                [10 ]University of Michigan College of Pharmacy, Ann Arbor, MI
                [11 ]University of Southern California School of Pharmacy, Los Angeles, CA
                [12 ]University of Minnesota College of Pharmacy, Minneapolis, MN
                [13 ]University of Illinois College of Pharmacy, Chicago, IL
                [14 ]University of Arkansas for Medical Sciences College of Pharmacy & Arkansas Children’s Hospital, Little Rock, AR
                [15 ]Albany Medical Center Hospital, Albany, NY
                © 2020


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