Vancomycin redistribution : dosing recommendations following high-flux hemodialysis

• Published in: Kidney international Vol. 45; no. 1; pp. 232 - 237
• Main Authors: POLLARD, T. A, LAMPASONA, V, AKKERMAN, S, TOM, K, HOOKS, M. A, MULLINS, R. E, MARONI, B. J
• Format: Conference Proceeding Journal Article
• Language: English
• Published: New York, NY Nature Publishing 1994
• Subjects: Adult; Antibacterial agents; Antibiotics. Antiinfectious agents. Antiparasitic agents; Biological and medical sciences; Catheters, Indwelling - adverse effects; Dose-Response Relationship, Drug; Female; Humans; Male; Medical sciences; Middle Aged; Osmolar Concentration; Pharmacology. Drug treatments; Preoperative Care; Renal Dialysis - methods; Thrombectomy; Tissue Distribution; Vancomycin - administration & dosage; Vancomycin - blood; Vancomycin - therapeutic use; Human; Postoperative; Prevention; Extrarenal dialysis; Antibiotic; Chemoprophylaxis; Intravenous administration; Hemodialysis; Aminoglycoside; Antibacterial agent; Pharmacokinetics
• ISSN: 0085-2538; 1523-1755
• DOI: 10.1038/ki.1994.28

Although increased vancomycin clearance has been reported with highly permeable hemodialysis membranes (such as polysulfone), failure to consider post-dialysis redistribution could lead to unnecessary dosage supplementation. In protocol 1, twelve hemodialysis patients admitted for vascular access thrombectomy received 15 mg/kg of vancomycin as surgical prophylaxis. Post-operatively, patients underwent high-flux hemodialysis (HFHD) for two hours using a Fresenius F-80 polysulfone dialyzer (QB = 417 +/- 49, QD = 800 ml/min). Vancomycin's intradialytic clearance increased 13-fold compared to the patient's endogenous clearance (120 +/- 59 vs. 9 +/- 8 ml/min, respectively) yet dialysate recovery indicated that only 17% of body stores were removed (179 +/- 70 mg). Although serum vancomycin levels decreased 33% during HFHD, vancomycin levels increased in all patients following dialysis and the post-rebound values reached 87% of the pre-dialysis concentration. In protocol 2, eight outpatients receiving maintenance HFHD with a F-80 dialyzer (Kt/V = 1.29 +/- 0.08) were given 20 mg/kg of vancomycin immediately following dialysis on Monday; pre- and post-levels were measured during the next three dialysis treatments. The predialysis serum vancomycin levels were > 7.5 micrograms/ml (9.7 +/- 1.0 micrograms/ml; range 8.0 to 11.0) in all patients the following Monday. Thus, vancomycin clearance is increased during HFHD, but redistribution post-HD minimizes changes in serum levels. We recommend a 20 mg/kg i.v. loading dose and subsequent doses of 15 mg/kg every seven days; to account for individual variability, weekly vancomycin levels should be drawn before dialysis.