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Previous issue date: 2013-11-29 / Background: The current study aims to test and a vancomycin protocol based on the initial hemodialysis patients weight and to describe drug peak and through serum levels. Methods: A study enrolling 16 ESRD adult patients cohort undergoing hemodialysis received a uniform vancomycin administration schedule: 20 mg/kg initial dose, infused during the last dialysis hour; blood sample collection 30 minutes post-dialysis and, subsequently, before every dialysis session. Additionally, a fixed schedule to adjust every new dose was used. Anthropometric, clinical and laboratory variables were collected. Descriptive statistics was used; Spearman correlation coefficient was used to verify associations. Results: No significant correlation between vancomycin peak serum level and trough levels and the initial dose, nor any trough level and the following doses were uncovered. However, total serum protein strong and positively correlated with the initial Vancomycin dose and the first trough serum level (rs = 0.608, P = 0.016 and rs= 0.641; P = 0.010, respectively). Initial dose positively correlated with albumin too (rs= 0.572, P = 0.02). A strong correlation between the first and second trough levels was also found (rs = 0.608; P = 0.021). Conclusion: As applied, the vancomycin administration protocol was ineffective in reaching and maintaining therapeutic peak and trough levels. It is possible that a significant loss of vancomycin free-fraction by dialysis accounted for such a finding. Correlation of vancomycin serum levels between total serum proteins should be further investigated. / Objetivo Descrever os n?veis s?ricos de vancomicina em amostras coletadas nos vales em pacientes em hemodi?lise, a partir de um protocolo de administra??o deste antimicrobiano com dose inicial de 20mg/kg seguida de 10mg/kg e ajustes nas doses subsequentes, conforme a faixa de vancocinemia obtida e correlacionar com par?metros fisiol?gicos para verificar poss?veis associa??es. M?todos Estudo de coorte onde foram inclu?dos pacientes em hemodi?lise ambulatorial, com idade igual ou superior a 18 anos que realizaram tratamento com vancomicina, emp?rico ou com germe isolado. O medicamento foi administrado por infus?o intravenosa numa concentra??o de 10mg/mL na ?ltima hora da sess?o de hemodi?lise. O protocolo proposto baseia-se em doses administradas a cada sess?o de di?lise, realizadas tr?s vezes na semana, considerando o peso do paciente, uma dose inicial e define ajustes de dose a cada vancocinemia, com o objetivo de mant?-la nos n?veis terap?uticos estabelecidos de 10 a 20mg/L. Resultados: N?o houve correla??o significativa entre as concentra??es de vancomicina s?rica no pico e vales com as doses definidas pelo protocolo. Entretanto, o primeiro vale e as prote?nas plasm?ticas apresentaram forte correla??o positiva (rs = 0.608, P = 0.01), al?m da dose inicial tamb?m se correlacionar positivamente com as prote?nas plasm?ticas e albumina (rs = 0.641, P = 0.01 e rs= 0.572, P = 0.02). Os n?veis s?ricos de vancomicina entre o primeiro e o segundo vales apresentam forte correla??o positiva (rs = 0.608, P = 0.02) e o volume de distribui??o apresenta forte correla??o inversa ao valor de pico de vancomicina (rs = - 0.990; P < 0.001). Conclus?o Embora o estudo n?o tenha sido capaz de determinar um protocolo, identificamos uma variabilidade muito grande entre os resultados de vancocinemia. Doses mesmo ajustadas pelo peso seco do paciente e n?veis s?ricos de vancomicina n?o foram suficientes para manter os n?veis terap?uticos de vancomicina. ? poss?vel que haja perda significativa de vancomicina durante a hemodi?lise. A correla??o com as prote?nas plasm?ticas pode ser sugestiva quanto ? prote??o na remo??o durante a di?lise, por?m necessita ser investigada.
| Identifer | oai:union.ndltd.org:IBICT/oai:tede2.pucrs.br:tede/1768 |
| Date | 29 November 2013 |
| Creators | Isoppo, Catherine Stragliotto |
| Contributors | D'avila, Domingos Otavio Lorenzoni |
| Publisher | Pontif?cia Universidade Cat?lica do Rio Grande do Sul, Programa de P?s-Gradua??o em Medicina e Ci?ncias da Sa?de, PUCRS, BR, Faculdade de Medicina |
| Source Sets | IBICT Brazilian ETDs |
| Language | Portuguese |
| Detected Language | English |
| Type | info:eu-repo/semantics/publishedVersion, info:eu-repo/semantics/masterThesis |
| Format | application/pdf |
| Source | reponame:Biblioteca Digital de Teses e Dissertações da PUC_RS, instname:Pontifícia Universidade Católica do Rio Grande do Sul, instacron:PUC_RS |
| Rights | info:eu-repo/semantics/openAccess |
| Relation | 7620745074616285884, 500, 600, -8624664729441623247 |
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