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Over 90% of the dose is excreted in the urine, therefore there is a risk of accumulation in patients with renal impairment, so therapeutic drug monitoring (TDM) is recommended. [citation needed] Oral preparations of vancomycin are available, however, they are not absorbed from the lumen of the gut, so are of no use in treating systemic infections.
The primary sign of augmented renal clearance is an increase in the creatinine clearance well above that which would be considered normal. Commonly, ARC is defined as a creatinine clearance of greater than 130 mL/min, but the effects of increased clearance on therapy are not directly correlated to a specific number.
Vancomycin is recommended to be administered in a dilute solution slowly, over at least 60 min (maximum rate of 10 mg/min for doses >500 mg) [21] due to the high incidence of pain and thrombophlebitis and to avoid an infusion reaction known as vancomycin flushing reaction. This phenomenon has been often clinically referred to as "red man syndrome".
For example, gentamicin is an antibiotic that can be nephrotoxic (kidney damaging) and ototoxic (hearing damaging); measurement of gentamicin through concentrations in a patient's plasma and calculation of the AUC is used to guide the dosage of this drug. [3] AUC becomes useful for knowing the average concentration over a time interval, AUC/t.
A drug of last resort (DoLR), also known as a heroic dose, [1] is a pharmaceutical drug which is tried after all other drug options have failed to produce an adequate response in the patient. Drug resistance , such as antimicrobial resistance or antineoplastic resistance , may make the first-line drug ineffective, especially in case of ...
Some investigators have proposed dosing based on surface area (S) instead of V, but clinicians usually measure the URR and then calculate Kt/V. One can "adjust" the Kt/V, to calculate a "surface-area-normalized" or "SAN"-Kt/V as well as a "SAN"-standard Kt/V. This puts a wrapper around Kt/V and normalizes it to body surface area. [8]
S and V differ markedly between small vs. large people and between men and women. A man and a woman of the same S will have similar levels of GFR, but their values for V may differ by 15-20%. Because standardized Kt/V incorporates residual renal function into the calculations, it makes the assumption that kidney function should scale by V.
There are various forms, [2] and some drugs may affect kidney function in more than one way. Nephrotoxins are substances displaying nephrotoxicity. Nephrotoxicity should not be confused with some medications predominantly excreted by the kidneys needing their dose adjusted for the decreased kidney function (e.g., heparin, lithium).