Clinical Guideline No. CG251: Vancomycin Dosing

Podcast

Play an AI-generated podcast conversation about this lesson

Questions and Answers

What is the primary purpose of therapeutic drug monitoring in patients treated with vancomycin for longer than 48 hours?

To prescribe additional medications as necessary

To evaluate the patient’s overall health status

To ensure cost-effectiveness of the treatment

To avoid under-dosing and minimize risk of toxicity (correct)

What is the target 24-hour AUC/MIC ratio for clinical success with vancomycin?

300 or more

400 or more (correct)

500 or more

600 or more

Which method is commonly used as a surrogate measure of vancomycin efficacy for practical reasons?

Trough plasma concentration (correct)

Total body clearance

Serum creatinine level

Peak plasma concentration

In which of the following scenarios is monitoring and dose adjustment particularly critical?

Patients with renal impairment Signup and view all the answers

What is the primary consideration for dosing in obese patients receiving vancomycin?

Individualized dosing adjustments based on body weight may be necessary Signup and view all the answers

What condition should be assessed during continuous infusions of vancomycin?

AUC/MIC to ensure efficacy Signup and view all the answers

What specific patient population requires careful dosing and monitoring due to the risk of MRSA infection?

Patients allergic to penicillin Signup and view all the answers

Which of the following statements regarding vancomycin treatment is NOT correct?

Therapeutic drug monitoring is unnecessary for short treatments. Signup and view all the answers

What is the definition of BMI?

Bodyweight in kilograms divided by height in meters squared Signup and view all the answers

What does the acronym AUC/MIC represent?

Ratio of area under the curve to minimum inhibitory concentration Signup and view all the answers

When should maintenance dosing begin after a loading dose for a patient with a CrCl greater than or equal to 40 mL/min?

12 hours after the loading dose Signup and view all the answers

What is the recommended loading dose of vancomycin for adults, based on body weight?

25 mg/kg of actual body weight Signup and view all the answers

What should be done if CrCl is less than 20 mL/min after administration of a loading dose?

Check trough level 24 hours after loading dose and wait for level to fall below 20 mg/L Signup and view all the answers

What does the acronym CrCl stand for?

Creatinine Clearance Signup and view all the answers

For which of the following conditions may a higher loading dose be required?

Sepsis Signup and view all the answers

Which parameter should not be used for dosing vancomycin?

eGFR Signup and view all the answers

What is the primary purpose of the statewide guideline?

To promote standardisation and consistency of practice Signup and view all the answers

What is the target trough level for intermittent infusion of vancomycin?

15 - 20 mg/L Signup and view all the answers

Which responsibility does not fall under the individual clinician's scope according to the guideline?

Prohibiting the use of interpreter services Signup and view all the answers

What must a clinician document if they choose to deviate from the guideline?

The decision made and detailed reasons for it Signup and view all the answers

What is the recommended blood concentration target for continuous infusion at steady state?

20 - 25 mg/L Signup and view all the answers

What is the recommended infusion duration for a 1g dose of vancomycin?

60 minutes Signup and view all the answers

In which patient population might continuous infusion of vancomycin be preferable?

Patients with augmented renal function Signup and view all the answers

What happens if switching from intermittent dosing to continuous infusion?

The starting dose over 24 hours remains the same as the total dose for 24 hours from intermittent infusion. Signup and view all the answers

What is the primary concern when administering higher doses of vancomycin?

Increased risk of red man syndrome Signup and view all the answers

What action should clinicians take in cases where the guideline does not apply?

Document the departure and reasons in the patient's medical record Signup and view all the answers

Which of the following is NOT mentioned as a requirement for health practitioners?

Conducting all discussions publicly Signup and view all the answers

How does the molecular weight of vancomycin affect its administration?

It complicates penetration into cerebrospinal fluid. Signup and view all the answers

What dilution is commonly used for vancomycin administration?

5 mg/mL Signup and view all the answers

What dose reduction is recommended when converting from intermittent to continuous infusion for patients with levels at the upper end of the target range?

20% Signup and view all the answers

What is the recommended initial loading dose for critically ill patients initiated on continuous vancomycin infusion?

Twice the intermittent maintenance dose Signup and view all the answers

When is it appropriate to measure blood concentrations of vancomycin during continuous infusion?

At any time once steady-state is achieved Signup and view all the answers

In which scenario should levels of vancomycin be measured earlier than 36-48 hours after infusion initiation?

If the patient is critically ill Signup and view all the answers

What is the maximum recommended infusion rate for vancomycin to avoid Red Man syndrome?

1g/hour Signup and view all the answers

What should be done first if a patient exhibits symptoms of an infusion-related reaction to vancomycin?

Cease the infusion Signup and view all the answers

Which of the following is a symptom of Red Man syndrome related to vancomycin infusion?

Flushing and erythematous rash Signup and view all the answers

What should be administered if a patient experiences hypotension during an infusion reaction to vancomycin?

Antihistamine (cetirizine) Signup and view all the answers

Study Notes

Clinical Guideline Overview

Clinical Guideline No. CG251 focuses on vancomycin dosing and monitoring in adults, version 1.1 approved on 30/12/2019.
Aims to standardize practice using a multidisciplinary approach, emphasizing evidence and expert opinion.

Monitoring and Safety

Therapeutic drug monitoring (TDM) is recommended for vancomycin use beyond 48 hours to prevent under-dosing and minimize toxicity, especially in renal impairment cases.
AUC/MIC ratio is crucial for efficacy, with a target of AUC/MIC ≥400; trough levels serve as a practical surrogate measure.

Dosing Guidelines

Loading Dose: 25 mg/kg (actual body weight) advised; higher doses may be necessary for critically ill patients (e.g., meningitis).
Maintenance Dose: Initiated 12 hours post-loading if CrCl ≥40 mL/min, or 24 hours if CrCl is 20-39 mL/min.
Trough Levels:
- Intermittent infusion aim: 15-20 mg/L.
- Continuous infusion aim: 20-25 mg/L at steady state.

Administration Protocol

Infusion of 1g over at least 60 minutes; additional time recommended for larger doses to mitigate ‘red man syndrome’.
Standard dilution: 5 mg/mL; up to 10 mg/mL for fluid-restricted patients.

Special Considerations

Continuous Infusions: Preferred in difficult-to-manage cases; dosing based on total doses from intermittent schedules.
Adjustments made linearly; monitoring recommended every 2-3 days, or more frequent in unstable renal function scenarios.

Adverse Reactions

Red Man Syndrome:
- Related to infusion speed; symptoms include pruritus, flushing, rash, fever, chills, hypotension.
- Treatment protocol involves ceasing infusion, administering antihistamines, and requesting emergency assistance if hypotension occurs.

Definitions and Acronyms

ABW: Actual Body Weight
AUC/MIC: Area Under the Curve/Minimum Inhibitory Concentration
CrCl: Creatinine Clearance
MRSA: Methicillin-resistant Staphylococcus aureus
TDM: Therapeutic Drug Monitoring

Studying That Suits You

Use AI to generate personalized quizzes and flashcards to suit your learning preferences.

Description

This quiz covers the essentials of Clinical Guideline No. CG251, focusing on vancomycin dosing and monitoring practices for adults. Key topics include therapeutic drug monitoring, dosing recommendations, and safety measures. Ideal for healthcare professionals looking to enhance their understanding of vancomycin use.