Janice Richardson1, Marc Scheetz2, E Paul O'Donnell3. 1. Captain James A. Lovell Federal Health Care Center, 3001 Green Bay Rd, North Chicago, IL 60064, USA; Mercy Hospital & Medical Center, 2525 S. Michigan Avenue, Chicago, IL 60616, USA. Electronic address: Janice.Richardson2@va.gov. 2. Midwestern University, Chicago College of Pharmacy, 555 31st St, Downers Grove, IL 60515, USA; Northwestern Memorial Hospital, Department of Pharmacy, 251 E. Huron St., Chicago, IL 60611, USA. Electronic address: mschee@midwestern.edu. 3. Mercy Hospital & Medical Center, 2525 S. Michigan Avenue, Chicago, IL 60616, USA; Midwestern University, Chicago College of Pharmacy, 555 31st St, Downers Grove, IL 60515, USA; Rush University Medical Center, Department of Pharmacy, 1653 W. Congress Pkwy., Chicago, IL 60612, USA. Electronic address: podonn@midwestern.edu.
Abstract
BACKGROUND: Obese patients display differences in vancomycin drug disposition, which may complicate attainment of appropriate serum vancomycin concentrations (SVCs). This study was conducted to determine if obesity leads to trough SVCs above the therapeutic range. METHODS: This retrospective cohort study sought to determine the rate and predictors of high (i.e. >20 mg/L) serum trough levels according to level of obesity. RESULTS: Increasing BMI predicted SVCs > 20 mg/L after controlling for dose, age, and serum creatinine. Obese patients had significantly higher mean trough SVCs compared to non-obese patients (16.5 mg/L vs 12.1 mg/L, p = 0.004) and a significantly higher proportion of obese patients had trough SVCs > 20 mg/L (18.9% vs 4.2%, p = 0.03). CONCLUSION: Increasing obesity predicted higher probabilities of SVCs > 20 mg/L. Development of alternative dosing and management strategies for vancomycin may be necessary to account for pharmacokinetic changes associated with obesity.
BACKGROUND:Obesepatients display differences in vancomycin drug disposition, which may complicate attainment of appropriate serum vancomycin concentrations (SVCs). This study was conducted to determine if obesity leads to trough SVCs above the therapeutic range. METHODS: This retrospective cohort study sought to determine the rate and predictors of high (i.e. >20 mg/L) serum trough levels according to level of obesity. RESULTS: Increasing BMI predicted SVCs > 20 mg/L after controlling for dose, age, and serum creatinine. Obesepatients had significantly higher mean trough SVCs compared to non-obesepatients (16.5 mg/L vs 12.1 mg/L, p = 0.004) and a significantly higher proportion of obesepatients had trough SVCs > 20 mg/L (18.9% vs 4.2%, p = 0.03). CONCLUSION: Increasing obesity predicted higher probabilities of SVCs > 20 mg/L. Development of alternative dosing and management strategies for vancomycin may be necessary to account for pharmacokinetic changes associated with obesity.
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