In this episode, I’ll discuss the possibility of vancomycin treatment failure with old CVVHDF dosing regimens.
A very common starting regimen to attain target trough levels for vancomycin during CVVHDF is a 2 gram IV loading dose followed by 750 mg IV q12h.
However a group of authors in Bruggman Belgium have noted that this regimen was derived from data collected 7 years ago when a non-absorptive dialysis membrane was commonly used.
These authors note that in contemporary practice, more than 95% of patients treatmented with the Prismaflex machine use an absorptive membrane.
Based on studies of the absorption capacities of this membrane, the authors conclude that up to one-third of the initial dose could be absorbed by the membrane, which could very well prevent the attainment of target vancomycin levels.
In a retrospective study done by the authors and described in the letter to the editor, vancomycin maintenance doses close to 3,000 mg daily were needed during the first 3 treatment days.
Pharmacists should be aware of the absorptive capacity of CVVHDF membranes in use at their institutions and vancomycin in particular should be monitored to identify when absorption is preventing the attainment of adequate levels.
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