Pharmacokinetics of Vancomycin among Patients with Chemotherapy-Associated Febrile Neutropenia: Which Would Be the Best Dosing to Obtain Appropriate Exposure?

Abstract

Previous research has determined that the required doses for treating febrile neutropenia with vancomycin are higher than the doses used conventionally. These recommendations have been made considering pharmacotherapeutic goals based on minimum concentration ((Formula presented.)) between 15–20 (Formula presented.). This study was developed to evaluate dose recommendations based on the achievement of a target consisting of ratio of area under the curve over minimum inhibitory concentration ((Formula presented.)) (Formula presented.) in this population of individuals. This study was conducted in a referral hospital for cancer treatment, study participants received vancomycin doses of (Formula presented.) every 12 h in 2-4-h infusions. Vancomycin was described by a two-compartment pharmacokinetic model with clearance dependent on the estimated glomerular filtration rate. Simulations were performed taking into account a reduced version of the model to establish the influence of controllable and non-controllable variables on the probability of achieving several PK-PD targets. A dose of (Formula presented.) in patients with estimated glomerular filtration rate ((Formula presented.)) between 80 and (Formula presented.) was adequate to achieve the pharmacotherapeutic target. A discrepancy was found between (Formula presented.) -based and (Formula presented.) -based PK/PD indices, the former being affected by the dose and creatinine clearance while the latter highly influenced by the interval between doses.