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Lewis SJ, Bodenhorn D, Na EY, Jang SM. Comparison of antimicrobial dosing recommendations in patients receiving intermittent hemodialysis among drug information resources. J Clin Pharm Ther 2021; 47:628-635. [PMID: 34866202 DOI: 10.1111/jcpt.13583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 11/11/2021] [Accepted: 11/23/2021] [Indexed: 11/28/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Tertiary drug information resources are frequently consulted for the optimal antimicrobial dosing in intermittent hemodialysis (IHD) patients. Yet, significant discrepancy may exist in dosing recommendations between resources. This study was to evaluate the consistency of antimicrobial dosing recommendations in IHD among four different drug information resources and the relevance of referenced pharmacokinetic studies. METHODS Dosing recommendations of 29 commonly prescribed antimicrobials in IHD patients were collected from Micromedex, LexiComp, Clinical Pharmacology and Drug Prescribing in Renal Impairment to compare dosing categorization and the total daily dose (TDD). Significant dosing discrepancies were defined as ≥30% difference. Referenced pharmacokinetic studies were evaluated for their relevance in current practice, using sample size, hemodialyzer types, the use of optimal pharmacodynamic targets and the consideration of different interdialytic dosing periods. RESULTS AND DISCUSSION A significant variation was found both in dosing categorization and recommended doses between resources. Seventeen drugs were compared for TDD with significant dosing discrepancy in 8 drugs. Among 42 referenced pharmacokinetic studies, 40 were evaluated. Mean patient numbers of pharmacokinetic studies were 13 ranging from 3 to 70. Sixty per cent of studies utilized contemporary hemodialyzers (e.g., high-flux and/or high efficiency). The optimal pharmacodynamic targets and the impact of different interdialytic intervals were assessed only in 27.5% and 7.5% respectively. WHAT IS NEW AND CONCLUSION Inconsistent antimicrobial dosing recommendations for IHD patients exist among four well-established resources. Many referenced pharmacokinetic studies utilized outdated or less pharmacodynamically relevant study methods. Newer studies are warranted to reflect contemporary dialysis practice and assess its impact on optimal antimicrobial dosing.
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Affiliation(s)
- Susan J Lewis
- Department of Pharmacy Practice, University of Findlay College of Pharmacy, Findlay, Ohio, USA.,Mercy Health - St. Anne Hospital, Toledo, Ohio, USA
| | | | - Eun-Young Na
- University of Findlay College of Pharmacy, Findlay, Ohio, USA
| | - Soo Min Jang
- Department of Pharmacy Practice, Loma Linda University School of Pharmacy, Loma Linda, California, USA
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Lewis SJ, Mueller BA. Evaluation and Development of Vancomycin Dosing Schemes to Meet New AUC/MIC Targets in Intermittent Hemodialysis Using Monte Carlo Simulation Techniques. J Clin Pharmacol 2020; 61:211-223. [PMID: 32851685 DOI: 10.1002/jcph.1727] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 08/03/2020] [Indexed: 11/09/2022]
Abstract
Published vancomycin dosing recommendations for patients receiving maintenance hemodialysis were not designed to meet newly recommended 24-hour area under the curve/minimum inhibitory concentration (AUC24h /MIC) pharmacokinetic/pharmacodynamic targets. The aims of this study were to predict pharmacokinetic/pharmacodynamic target attainment rates with a commonly used vancomycin regimen and to design a new dosing scheme incorporating therapeutic drug monitoring (TDM) to maximize target attainment in patients receiving vancomycin and hemodialysis with high- or low-flux hemodialyzers. Vancomycin pharmacokinetic- and dialysis-specific parameters were incorporated into Monte Carlo simulations (MCS). A commonly used vancomycin regimen was modeled to determine its likelihood of attaining AUC24h /MIC targets for 1 week of thrice-weekly hemodialysis treatments. MCS was then used to develop optimal initial vancomycin dosing for patients receiving intradialytic or postdialytic vancomycin administration with either high- or low-flux hemodialyzers. Finally, a new MCS model incorporating TDM was built to further optimize the probability of pharmacokinetic/pharmacodynamic target attainment. Traditional vancomycin dosing methods are unlikely to meet AUC24h /MIC targets. Vancomycin doses necessary to attain AUC24h /MIC targets are significantly influenced by hemodialyzer permeability and whether vancomycin is administered intradialytically or after hemodialysis. Depending on dialyzer type and whether vancomycin is administered during or after hemodialysis, loading doses of 25 to 35 mg/kg followed by maintenance doses of 7.5 to 15 mg/kg are necessary to reach minimum AUC24h /MIC targets in 90% of virtual patients. For a 3-day interdialytic period, a 30% higher maintenance dose is required to maintain target attainment. Dosing based on a single vancomycin serum concentration obtained prior to the second dialysis session greatly enhances the probability of target attainment.
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Affiliation(s)
- Susan J Lewis
- Department of Pharmacy Practice, University of Findlay College of Pharmacy, Findlay, Ohio, USA.,Pharmacy Department, Mercy Health-St. Anne Hospital, Toledo, Ohio, USA
| | - Bruce A Mueller
- Department of Clinical Pharmacy, University of Michigan College of Pharmacy, Ann Arbor, Michigan, USA
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3
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Analytical Quality by Design-based development and validation of ultra pressure liquid chromatography/MS/MS method for glycopeptide antibiotics determination in human plasma. Bioanalysis 2018; 10:1861-1876. [DOI: 10.4155/bio-2018-0181] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Aim: An ultra pressure liquid chromatography (UPLC)/MS/MS method for vancomycin and teicoplanin determination in human plasma was developed in accordance with analytical quality by design (AQbD) concept and fully validated. Materials & methods: Chromatographic separation was performed on ACQUITY UPLC C18 charge surface hybrid (CSH) column (2.1 mm × 50 mm, 1.7 μm particle size) in gradient mode and the mobile phase consisted of 0.1% formic acid in water and pure acetonitrile. The experimental design methodology was used for the definition of optimal chromatographic and protein precipitation conditions. Results: The linearity ranges were 0.05–10 μg ml-1 for vancomycin and 0.5–200 μg ml-1 for total teicoplanin. The relative standard deviations for precision estimation were below 15% and the accuracy was within 85–115% for all quality control levels. Conclusion: The method was utilized for glycopeptide antibiotics bioanalysis.
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Shi M, Zhao X, Wang T, Yin L, Li Y. A LC–MS-MS assay for simultaneous determination of two glycopeptides and two small molecule compounds in human plasma. J Chromatogr Sci 2018; 56:828-834. [PMID: 29905845 DOI: 10.1093/chromsci/bmy060] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Indexed: 12/12/2022]
Affiliation(s)
- Meiyun Shi
- School of Life Science and Medicine, Dalian University of Technology, No. 2 Dagong Road, New District of Liaodong Bay, Panjin, China
| | - Xiaojun Zhao
- The First Hospital of Jilin University, Changchun, Jilin, China
| | - Tingting Wang
- The First Hospital of Jilin University, Changchun, Jilin, China
- School of Life Science, Jilin University, Qianjin Street, Changchun, China
| | - Lei Yin
- The First Hospital of Jilin University, Changchun, Jilin, China
- School of Life Science, Jilin University, Qianjin Street, Changchun, China
| | - Yanyan Li
- The First Hospital of Jilin University, Changchun, Jilin, China
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Determination of Vancomycin in Human Serum by Cyclodextrin-Micellar Electrokinetic Capillary Chromatography (CD-MEKC) and Application for PDAP Patients. Molecules 2017; 22:molecules22040538. [PMID: 28350363 PMCID: PMC6154692 DOI: 10.3390/molecules22040538] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 03/18/2017] [Accepted: 03/22/2017] [Indexed: 02/03/2023] Open
Abstract
A simple and sensitive cyclodextrin-micellar electrokinetic capillary chromatography (CD-MEKC) method with UV detection was developed and validated for the determination of vancomycin (VCM) in serum. The separation was achieved in 14 min at 25 °C with a fused-silica capillary column of 40.2 cm × 50 mm i.d. (effective length 30.2 cm) and a run buffer containing 25 mM borate buffer with 50 mM sodium dodecylsulfonate (SDS) (pH 9.5) and 2% sulfobutyl-β-cyclodextrin (sulfobutyl-β-CD). Under optimal conditions for biological samples, good separations with high efficiency and short analysis time were achieved. Several parameters affecting the drug separation from biological matrices were studied, including buffer types, concentrations, and pHs. The methods were validated over the range of 0.9998-99.98 µg/mL. Calibration curves of VCM also showed good linearity (r² > 0.999). Intra- and interday precisions (relative standard deviation, RSD) were less than 5.80% and 7.38%, and lower limit of quantification (LLOQ) were lower than 1.0 μg/mL. The mean recoveries ranged between 84.03% and 91.69%. The method was successfully applied for monitoring VCM concentrations in serum of patients with peritoneal dialysis-associated peritonitis (PDAP). The assay should be applicable to pharmacokinetic studies and routine therapeutic drug monitoring of this drug in serum.
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SAKAMOTO Y, JINNO Y, SHINODZUKA I, IWASAKI Y, ITO R, SAITO K. Sample Cleanup Using Solid-Phase Dispersive Extraction for Determination of Vancomycin in Serum. ANAL SCI 2014; 30:271-5. [DOI: 10.2116/analsci.30.271] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Yasuhiro SAKAMOTO
- Department of Analytical Chemistry, Faculty of Pharmaceutical Sciences, Hoshi University
| | - Yuki JINNO
- Department of Analytical Chemistry, Faculty of Pharmaceutical Sciences, Hoshi University
| | - Ikumi SHINODZUKA
- Department of Analytical Chemistry, Faculty of Pharmaceutical Sciences, Hoshi University
| | - Yusuke IWASAKI
- Department of Analytical Chemistry, Faculty of Pharmaceutical Sciences, Hoshi University
| | - Rie ITO
- Department of Analytical Chemistry, Faculty of Pharmaceutical Sciences, Hoshi University
| | - Koichi SAITO
- Department of Analytical Chemistry, Faculty of Pharmaceutical Sciences, Hoshi University
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Pallotta KE, Manley HJ. Vancomycin Use in Patients Requiring Hemodialysis: A Literature Review. Semin Dial 2007; 21:63-70. [DOI: 10.1111/j.1525-139x.2007.00333.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Diana J, Visky D, Hoogmartens J, Van Schepdael A, Adams E. Investigation of vancomycin and related substances by liquid chromatography/ion trap mass spectrometry. RAPID COMMUNICATIONS IN MASS SPECTROMETRY : RCM 2006; 20:685-93. [PMID: 16447148 DOI: 10.1002/rcm.2364] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Liquid chromatography (LC) methods compatible with mass spectrometry (MS) that are suitable for impurity profiling of vancomycin mixtures have not been described in the literature. The mobile phases of the existing methods contain non-volatile additives and/or solvents that give problems in combination with MS. In this paper, a reversed-phase LC/tandem mass spectrometry method is described for the investigation of vancomycin and related substances. The LC method uses a Zorbax Extend C18 column (250 x 4.6 mm i.d.), 5 microm, and a mobile phase consisting of methanol, water and ammonium acetate solution (pH 9.0). This method allows us to separate vancomycin and its impurities. Mass spectral data are acquired on an LCQ ion trap mass spectrometer equipped with an electrospray interface operated in the positive and negative ion modes. The LCQ is ideally suited for identification of impurities and related substances because it provides on-line LC/MSn capability, which allows efficient identification without time-consuming isolation and purification procedures. Using this method, the fragmentation of vancomycin and known derivatives was studied and the structures of six substances occurring in commercial samples were elucidated.
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Affiliation(s)
- J Diana
- Katholieke Universiteit Leuven, Faculteit Farmaceutische Wetenschappen, Laboratorium voor Farmaceutische Chemie en Analyse van Geneesmiddelen, O & N2, PB 923, Herestraat 49, B-3000 Leuven, Belgium
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Diana J, Visky D, Roets E, Hoogmartens J. Development and validation of an improved method for the analysis of vancomycin by liquid chromatography selectivity of reversed-phase columns towards vancomycin components. J Chromatogr A 2003; 996:115-31. [PMID: 12830913 DOI: 10.1016/s0021-9673(03)00535-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The current method prescribed in official monographs for the purity control of vancomycin is inappropriate in that several components are not separated from each other and other components are coeluted with the main component vancomycin B. The method uses an ODS column at pH 3.2. In this study, several changes were introduced in order to improve the separation. The optimization of the separation method at low pH indicated that pH 1.7 was optimum and that the use of dioxane as organic modifier drastically improved the separation. These conditions were used to test a set of more than 40 reversed-phase columns for their selectivity towards vancomycin components. The selection of the most suitable columns was performed by means of principal component analysis. Most of these columns did not allow the separation of didechlorovancomycin from monodechlorovancomycin 1. It was found that neutral to slightly alkaline mobile phases allowed better separation. Further optimization of the separation method and a robustness study were performed by means of experimental design. This optimization indicated that pH 7.7 was optimum and gradient elution was also used to effect complete analysis. The final method uses a Kromasil column and the mobile phase comprises dioxane, water and ammonium formate solution pH 7.7. The separation of monodechlorovancomycin 2 and of some unknown impurities from the main component vancomycin B is described for the first time. The method shows good repeatability, linearity and sensitivity.
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Affiliation(s)
- José Diana
- Laboratorium voor Farmaceutische Chemie en Analyse van Geneesmiddelen, Faculteit Farmaceutische Wetenschappen, Katholieke Universiteit Leuven, E. Van Evenstraat 4, B-3000 Leuven, Belgium
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Favetta P, Guitto J, Bleyzac N, Dufresne C, Bureau J. New sensitive assay of vancomycin in human plasma using high-performance liquid chromatography and electrochemical detection. JOURNAL OF CHROMATOGRAPHY. B, BIOMEDICAL SCIENCES AND APPLICATIONS 2001; 751:377-82. [PMID: 11236095 DOI: 10.1016/s0378-4347(00)00484-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
A method using reversed-phase high-performance liquid chromatography with electrochemical detection for the analysis of vancomycin in human plasma was developed. Chromatographic conditions included an octadecyl column, a mobile phase of acetonitrile-sodium phosphate buffer (pH 7) (12:88), a total run time of 12 min, and coulometric electrochemical detection at +700 mV. Linear detector response was found in the range 5-100 microg ml(-1) after a 1:80 dilution or from 0.5 to 50 microg ml(-1) after a 1:20 dilution of the samples. In both cases the correlation coefficient (r) of the calibration curve standard was better than 0.995. Vancomycin determination was based on a denaturation of plasma proteins with methanol, then a dilution with mobile phase was performed. Recovery of vancomycin from plasma was 103.1+/-3.9%, and no interference from commonly used drugs or endogenous compounds was observed. A significant correlation was shown with the EMIT assay (r=0.92, P<0.001) using clinical samples from children. This HPLC technique is simple, sensitive, rapid, precise, selective and requires only 100 microl of plasma for completion.
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Affiliation(s)
- P Favetta
- Service de Pharmacie, H pital Lyon-Sud--Secteur Ste Eugénie, Pierre-Bénite, France
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Kingery JR, Sowinski KM, Kraus MA, Klaunig JE, Mueller BA. Vancomycin assay performance in patients with end-stage renal disease receiving hemodialysis. Pharmacotherapy 2000; 20:653-6. [PMID: 10853620 DOI: 10.1592/phco.20.7.653.35177] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
STUDY OBJECTIVE To compare the performance of polyclonal fluorescence polarization immunoassay (pFPIA) with that of enzyme-multiplied immunoassay technique (EMIT) in patients receiving vancomycin and hemodialysis. SETTING Outpatient hemodialysis center. PATIENTS Seven subjects with end-stage renal disease treated with hemodialysis 3 times/week with a cellulose triacetate hemodialyzer. INTERVENTION Subjects received vancomycin 1000 mg intradialytically during the first study session and 750 mg every other hemodialysis session thereafter for 4 weeks. MEASUREMENTS AND MAIN RESULTS Blood samples were obtained throughout the study, and vancomycin serum concentrations were determined by pFPIA and EMIT. The mean +/- SD difference (estimate of bias) between assays was -1.10 +/- 1.35 mg/L. The limits of agreement (mean difference +/- 1.96 x SD) between them were -3.80-1.60 mg/L. CONCLUSION Our data suggest that the manufacturer's changes in the vancomycin pFPIA eliminated overestimation of drug concentrations in patients undergoing high-permeability hemodialysis.
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Affiliation(s)
- J R Kingery
- Department of Pharmacy, Clarian Health Partners, Inc., Indiana University Hospital, Indianapolis, USA
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Smith PF, Morse GD. Accuracy of measured vancomycin serum concentrations in patients with end-stage renal disease. Ann Pharmacother 1999; 33:1329-35. [PMID: 10630833 DOI: 10.1345/aph.19130] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To review information related to the accuracy of vancomycin serum drug concentrations in patients with end-stage renal disease, focusing on available assays and mechanisms of cross-reactivity. DATA SOURCES Primary and review articles identified from a MEDLINE search (January 1980-June 1999) and through secondary sources. STUDY SELECTION AND DATA EXTRACTION All articles identified were evaluated, and all relevant information was included in this review. DATA SYNTHESIS Falsely elevated vancomycin serum concentrations may occur in patients with renal dysfunction. The underlying mechanism is due to the formation and accumulation of a pseudo-metabolite, the vancomycin crystalline degradation product (CDP). Vancomycin is converted to CDP when exposed to heat, including normal body temperature. Because the molecular structures of CDP and vancomycin are similar, both molecules are detected by polyclonal immunoassay systems used in clinical laboratories. This cross-reactivity leads to falsely elevated serum vancomycin concentrations in excess of 50-70%. Such large assay inaccuracies may result in improper dosage adjustments and therapeutic failures. A monoclonal immunoassay system has been developed that does not significantly cross-react with CDP. CONCLUSIONS To appropriately interpret laboratory results, it is essential for clinicians to be aware of the vancomycin-CDP cross-reactivity problem and to be familiar with the specific assay used to measure vancomycin concentrations in patients with renal dysfunction.
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Affiliation(s)
- P F Smith
- Department of Pharmacy Practice, School of Pharmacy, State University of New York at Buffalo, 14260, USA.
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Leal T, Dupret P, Hassoun A, Wallemacq PE. Topical Application of Eosin to Burns Produces Interference in Measurement of Serum Vancomycin by Fluorescence Polarization Immunoassay. Clin Chem 1997. [DOI: 10.1093/clinchem/43.7.1238] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
| | | | | | - Pierre E Wallemacq
- Dept. of Clin. Chem., University Hospital St. Luc, University of Louvain, 10 Hippocrate Ave., B-1200 Brussels, Belgium
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