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The Effect of Hypoalbuminemia on the Therapeutic Concentration and Dosage of Vancomycin in Critically Ill Septic Patients in Low-Resource Countries

PURPOSE: To determine whether severe hypoalbuminemia (<25 mg/L) has a significant effect on serum levels of vancomycin and whether it can effect vancomycin dosage regimen and the loading dose administration. MATERIAL AND METHODS: Prospective, cohort, and a single-center study included 61 patients...

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Autores principales: Kovacevic, Tijana, Miljkovic, Branislava, Mikov, Momir, Stojisavljevic Satara, Svjetlana, Dragic, Sasa, Momcicevic, Danica, Kovacevic, Pedja
Formato: Online Artículo Texto
Lenguaje:English
Publicado: SAGE Publications 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6537498/
https://www.ncbi.nlm.nih.gov/pubmed/31205457
http://dx.doi.org/10.1177/1559325819850419
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author Kovacevic, Tijana
Miljkovic, Branislava
Mikov, Momir
Stojisavljevic Satara, Svjetlana
Dragic, Sasa
Momcicevic, Danica
Kovacevic, Pedja
author_facet Kovacevic, Tijana
Miljkovic, Branislava
Mikov, Momir
Stojisavljevic Satara, Svjetlana
Dragic, Sasa
Momcicevic, Danica
Kovacevic, Pedja
author_sort Kovacevic, Tijana
collection PubMed
description PURPOSE: To determine whether severe hypoalbuminemia (<25 mg/L) has a significant effect on serum levels of vancomycin and whether it can effect vancomycin dosage regimen and the loading dose administration. MATERIAL AND METHODS: Prospective, cohort, and a single-center study included 61 patients whose vancomycin serum levels were measured in steady state. Vancomycin trough levels (C (min)) that were in the range 15 to 20 µg/mL were considered therapeutic and trough levels higher than 15 µg/mL were considered potentially nephrotoxic. RESULTS: In the group of patients with severe hypoalbuminemia, C (min) was significantly higher compared to the those with nonsevere hypoalbuminemia (>25 mg/L; 23.04 [19.14] vs 13.28 [11.28], P = .01). In the group of patients who received the vancomycin loading dose of 2 g, C (min) was significantly higher in patients with severe hypoalbuminemia compared to the patients with nonsevere hypoalbuminemia (34.52 [25.93] vs 15.37 [10.48], P = .04). CONCLUSION: In critically ill septic patients with severe hypoalbuminemia, there is a high probability that the loading dose of vancomycin is not necessary since it is associated with potentially toxic vancomycin C (min), while in the patients with nonsevere hypoalbuminemia the loading dose may be necessary to achieving therapeutic C (min).
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spelling pubmed-65374982019-06-14 The Effect of Hypoalbuminemia on the Therapeutic Concentration and Dosage of Vancomycin in Critically Ill Septic Patients in Low-Resource Countries Kovacevic, Tijana Miljkovic, Branislava Mikov, Momir Stojisavljevic Satara, Svjetlana Dragic, Sasa Momcicevic, Danica Kovacevic, Pedja Dose Response Original Article PURPOSE: To determine whether severe hypoalbuminemia (<25 mg/L) has a significant effect on serum levels of vancomycin and whether it can effect vancomycin dosage regimen and the loading dose administration. MATERIAL AND METHODS: Prospective, cohort, and a single-center study included 61 patients whose vancomycin serum levels were measured in steady state. Vancomycin trough levels (C (min)) that were in the range 15 to 20 µg/mL were considered therapeutic and trough levels higher than 15 µg/mL were considered potentially nephrotoxic. RESULTS: In the group of patients with severe hypoalbuminemia, C (min) was significantly higher compared to the those with nonsevere hypoalbuminemia (>25 mg/L; 23.04 [19.14] vs 13.28 [11.28], P = .01). In the group of patients who received the vancomycin loading dose of 2 g, C (min) was significantly higher in patients with severe hypoalbuminemia compared to the patients with nonsevere hypoalbuminemia (34.52 [25.93] vs 15.37 [10.48], P = .04). CONCLUSION: In critically ill septic patients with severe hypoalbuminemia, there is a high probability that the loading dose of vancomycin is not necessary since it is associated with potentially toxic vancomycin C (min), while in the patients with nonsevere hypoalbuminemia the loading dose may be necessary to achieving therapeutic C (min). SAGE Publications 2019-05-20 /pmc/articles/PMC6537498/ /pubmed/31205457 http://dx.doi.org/10.1177/1559325819850419 Text en © The Author(s) 2019 http://creativecommons.org/licenses/by-nc/4.0/ This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (http://www.creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).
spellingShingle Original Article
Kovacevic, Tijana
Miljkovic, Branislava
Mikov, Momir
Stojisavljevic Satara, Svjetlana
Dragic, Sasa
Momcicevic, Danica
Kovacevic, Pedja
The Effect of Hypoalbuminemia on the Therapeutic Concentration and Dosage of Vancomycin in Critically Ill Septic Patients in Low-Resource Countries
title The Effect of Hypoalbuminemia on the Therapeutic Concentration and Dosage of Vancomycin in Critically Ill Septic Patients in Low-Resource Countries
title_full The Effect of Hypoalbuminemia on the Therapeutic Concentration and Dosage of Vancomycin in Critically Ill Septic Patients in Low-Resource Countries
title_fullStr The Effect of Hypoalbuminemia on the Therapeutic Concentration and Dosage of Vancomycin in Critically Ill Septic Patients in Low-Resource Countries
title_full_unstemmed The Effect of Hypoalbuminemia on the Therapeutic Concentration and Dosage of Vancomycin in Critically Ill Septic Patients in Low-Resource Countries
title_short The Effect of Hypoalbuminemia on the Therapeutic Concentration and Dosage of Vancomycin in Critically Ill Septic Patients in Low-Resource Countries
title_sort effect of hypoalbuminemia on the therapeutic concentration and dosage of vancomycin in critically ill septic patients in low-resource countries
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6537498/
https://www.ncbi.nlm.nih.gov/pubmed/31205457
http://dx.doi.org/10.1177/1559325819850419
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