Characterization of variables for potential impact on vancomycin pharmacokinetics in thermal or inhalation injury

Katie Elder, David M. Hill, William Hickerson

Research output: Contribution to journalArticle

Abstract

Objective: To characterize the pharmacokinetics of vancomycin dosing in thermal or inhalation injury as they relate to percent total body surface area burn (TBSA) and days since injury (DSI). Methods: This retrospective 3-year study included patients with thermal or inhalation injury receiving vancomycin. Patient demographics and course data were collected using the institution's electronic medical record. Results: Six hundred and fifty-four patients were included in the study; 124 remained after exclusion. Clearance (CL) was augmented in patients closer to their date of injury. CL and total daily dose requirements significantly increased with larger percent TBSA injured that was independent of volume of distribution (Vd). Larger percent TBSA also predicted increased occurrence of renal injury prior to vancomycin initiation. A modified sample set was also analyzed to control for renal dysfunction. Creatinine clearance (CrCl) estimated via the Cockcroft-Gault equation significantly impacted CL and total daily dose. To obtain a goal trough of 15–20 mg/L, the average patient in the modified sample with ≥10% TBSA required 64.7 mg/kg/day (or 16.2 mg/kg every 6 hours). Conclusions: DSI, percent TBSA, and CrCl can be used to predict faster vancomycin CL and need for higher total daily doses. Augmented pharmacokinetics can occur as early as two days after injury and decrease with time. Acceptable target trough attainment is still lacking and this data should assist in performance improvements for initial vancomycin dosing.

Original languageEnglish (US)
Pages (from-to)658-664
Number of pages7
JournalBurns
Volume44
Issue number3
DOIs
StatePublished - May 1 2018

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Vancomycin
Inhalation
Body Surface Area
Pharmacokinetics
Hot Temperature
Wounds and Injuries
Creatinine
Kidney
Electronic Health Records
Demography

All Science Journal Classification (ASJC) codes

  • Surgery
  • Emergency Medicine
  • Critical Care and Intensive Care Medicine

Cite this

Characterization of variables for potential impact on vancomycin pharmacokinetics in thermal or inhalation injury. / Elder, Katie; Hill, David M.; Hickerson, William.

In: Burns, Vol. 44, No. 3, 01.05.2018, p. 658-664.

Research output: Contribution to journalArticle

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