Case Report
Copyright ©The Author(s) 2022.
World J Clin Cases. Jun 26, 2022; 10(18): 6218-6226
Published online Jun 26, 2022. doi: 10.12998/wjcc.v10.i18.6218
Table 2 Literature on dose adjustment analysis of vancomycin in obese patients
Title (year)
Pharmacokinetics of vancomycin in extremely obese patients with suspected or confirmed staphylococcus aureus infections (2015)Prospective pharmacokinetic studyWhen 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, respectivelyAdane 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 reviewVd is 0.69 L/kg IBW in normal females compared with 0.58 in menVancomycin dosing can be improved by adapting the initial estimates of Vd in obese peopleDucharme 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 studySignificant 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 individualsBlouin 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 collectionPatients 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 concentrationsTBW should be considered for the initial doseRoberts 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 studyMaintenance dose > 4500 mg/d is not required in obese patients to reach the pharmacodynamic AUC targetUsing AUC-targeted TDM can optimize the treatment of obese adultsCrass 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 studyThe two-compartmental first-order elimination modelIn 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 increaseKatip et al[52]
To investigate the pharmacokinetics of vancomycin in patients with early septic shockThe mean ± SD of the total vancomycin clearance (3.70 ± 1.25 L/h) was higher than in patients with non-septic shock
n = 12There 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 samplingAdequate initial doses were achieved in 93.9% of overweight patients and 27.7% of obese patientsThe patient receives a weight-based doseHall 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 troughsCompared with the original strategy, the revised strategy improved the attainment of target trough concentrations with minimal nephrotoxicityReynolds 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