Vancomycin dosing in an obese patient with acute renal failure: A case report and review of literature

Table 2 Literature on dose adjustment analysis of vancomycin in obese patients

Title (year)	Design	Results	Conclusions	Ref.
Pharmacokinetics of vancomycin in extremely obese patients with suspected or confirmed staphylococcus aureus infections (2015)	Prospective pharmacokinetic study	When the minimum inhibitory concentration (MIC) was 1 μg/ml, the probability of the concentration-time curve (AUC)/MIC rate of 400 for vancomycin at 4000 to 5000 mg/d was 93%	Vd and clearance of vancomycin were affected by total body weight, respectively	Adane et al[18]
	To assess vancomycin pharmacokinetic parameters in obese patients
	n = 31
Vancomycin pharmacokinetics in a patient population: effect of age, gender, and body weight (1994)	Retrospective review	Vd is 0.69 L/kg IBW in normal females compared with 0.58 in men	Vancomycin dosing can be improved by adapting the initial estimates of Vd in obese people	Ducharme et al[21]
	Comparative pharmacokinetics of vancomycin using steady-state peak and trough serum concentrations
		The Vd for obese women and men was 1.17 and 0.90 L/kg IBW respectively
	n = 704
Vancomycin pharmacokinetics in normal and morbidly obese subjects (1982)	An uncontrolled study	Significant differences in mean terminal half-life and volume of distribution values between normal and morbidly obese individuals	TBW should be used for dosing of vancomycin in obese individuals	Blouin et al[22]
	Vancomycin pharmacokinetics was determined in normal and morbidly obese populations
	n = 10
		Strong correlations between TBW and Vd and total body clearance
Vancomycin dosing in critically ill patients: robust methods for improved continuous-infusion regimens (2011)	A retrospective data collection	Patients with a creatinine clearance of 100 ml/min/1.73 m2 should receive a continuous infusion at least 35 mg/kg/d to maintain target concentrations	TBW should be considered for the initial dose	Roberts et al[39]
	To perform a pharmacokinetic analysis of vancomycin in subjects
			The maintenance dose can be directed by creatinine clearance
	n = 206
Dosing vancomycin in the super obese: less is more (2018)	Retrospective study	Maintenance dose > 4500 mg/d is not required in obese patients to reach the pharmacodynamic AUC target	Using AUC-targeted TDM can optimize the treatment of obese adults	Crass et al[40]
	Determining an experiential vancomycin dosing strategy for obese individuals
	n = 346
The pharmacokinetics of vancomycin during the initial loading dose in patients with septic shock (2016)	A prospective, non-comparative study	The two-compartmental first-order elimination model	In the early stages of septic shock, the total clearance of vancomycin increased, while the volumes of distribution of the central and peripheral compartments did not increase	Katip et al[52]
	To investigate the pharmacokinetics of vancomycin in patients with early septic shock	The mean ± SD of the total vancomycin clearance (3.70 ± 1.25 L/h) was higher than in patients with non-septic shock
	n = 12	There was no increase in the volume of the central compartment (8.34 ± 4.36 L) or the volume of peripheral compartment (30.99 ± 7.84 L) compared to patients with non-septic shock
Multicenter evaluation of vancomycin dosing: emphasis on obesity (2008)	A random sampling	Adequate initial doses were achieved in 93.9% of overweight patients and 27.7% of obese patients	The patient receives a weight-based dose	Hall et al[53]
	Patients receiving vancomycin were categorised by body mass index and randomly chosen from the computer-generated query
	n = 421
Performance of a vancomycin dosage regimen developed for obese patients (2012)	Retrospective review	Revised strategy resulted in a higher frequency of target troughs	Compared with the original strategy, the revised strategy improved the attainment of target trough concentrations with minimal nephrotoxicity	Reynolds et al[54]
	Comparison of original and revised dosing regimens for achieving target serum trough concentrations and occurrence of nephrotoxicity in obese subjects
	n = 138

V_d: Distribution; TBW: Total body weight; IBW: Ideal body weight; TDM: Therapeutic drug monitoring; AUC: Concentration-time curve; MIC: Minimum inhibitory concentration.