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Weight-based vancomycin dosing could improve MRSA treatment in rural areas
In a rural setting, high rates of invasive MRSA bacteremia combined with limited antibiotic choices in the field may contribute to shorter courses of vancomycin, according to research published in the Canadian Journal of Rural Medicine.
Further investigation into clinical severity and overall selection of antibiotics is required, with weight-based dosing a potential solution to achieve target serum levels more frequently, according to researchers.
“Most courses of vancomycin were brief, and more work is required to assess the appropriateness of vancomycin use and duration of therapy in rural and remote settings,” the researchers wrote.
Megan Bollinger, MD, of the Northern Ontario School of Medicine, Sioux Lookout, Ontario, Canada, and colleagues retrospectively audited the charts of patients who received intravenous vancomycin at a rural hospital in the northwestern part of the province over 3 years; data included patient demographics, clinical diagnosis and vancomycin dose and course.
The investigators also looked at concurrent antibiotics, monitoring parameters for vancomycin trough level (prior to fourth dose) and serum creatinine, culture results, sensitivities and patient disposition. Target vancomycin levels were defined as 15 to 20 mg/L.
For adult patients with normal renal function, the researchers noted three common dosing methods: 1 g intravenously every 12 hours; 15 mg/kg intravenously every 12 hours; and loading dose of 25 to 30 mg/kg, followed in 12 hours by one of the two previously mentioned doses every 12 hours. The researchers’ institution typically used the first method.
During the study period, 180 patients were treated with intravenous vancomycin. The courses were 3 days on average; serum levels were below target 72% of the time.
“Our results show areas in which further education can be done in our hospital to improve dosing strategies and monitoring, and to encourage reflection on antibiotic choices,” the researchers wrote. “Empiric dosing may deliver subtherapeutic serum levels in our population, and weight-based dosing may be more appropriate.” – by Allegra Tiver
Disclosure: The researchers report no relevant financial disclosures.