MDR Bacterial Infections Our Treatment Option

One Gram bid: Enough for Vancomycin?Conclusions:1. Parameter best predicts vancomycin efficacy is AUC/MIC(= 400 mg.h/L is adequate for MRSA MIC ≤ 0.5 mg/L)2. No relationship between Time>MIC and response3. Trough serum conc. can be used as surrogate measure of AUC(optimal trough level 15-20 mg/L)4. 1 gm q 12 h is suboptimal for 80 kg patient with normal renalfunction (AUC/MIC = 250 mg.h/L) for MRSA MIC > 1 mg/L5. A daily dose of 3-4 gm. required for 100 & 90% target attainment(AUC/MIC = 400) for a MIC S. aureus = 0.5 & 1 mg/L respectively6. Mean trough level = 20 mg/L AUC/MIC = 418 mg.h/L7. If MIC S. aureus = 2 mg/L, probability of target attainment = 0Rybak M, Lomaestro B, Rotschafer JC, Moellering R, Craig W, Billeter M, et al. Therapeutic monitoring of vancomycin in adult patients: A consensus review of the American Society of Health-System Pharmacists, the Infectious Diseases Society of America, and the Society of Infectious Diseases Pharmacists. Am J Health Syst Pharm 2009;66(1):82-98.