Vancomycin Pharmacokinetics and Pharmacodynamics

Questions provided by Michele Splinter, Pharm.D.

You are asked to start vancomycin therapy in a patient who has pneumonia secondary to penicillin and cephalosporin resistant Streptococcus pneumoniae.

Patient characteristics
Age: 66 yrGender: maleWeight: 51.4 kght: 73 in
Scr: 1.82 mg/dLOrganism MIC 0.5 mg/L

A. Using the following population based estimates for vancomycin:

Vancomycin kel (hr-1) = 0.0044 + 0.00083 * (CLcr in mL/min)
Vancomycin Vd = 0.7 L/Kg * (Total Body Weight in Kg)

Calculate kel, t1/2, Vd, CL.

B. Use the calculated patient parameters to determine a dosing interval (to the nearest 12 hr), infusion duration (to the nearest 15 minutes) and maintenance dose (to the nearest 250 mg) to produce a Cpmaxss of 60 mg/L and a Cpminss of 20 mg/L. Calculate the projected Cpmaxss and Cpminss on the new regimen.

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Some Equations:

IBW equation (male)
Equation 27.5.1 IBW for Male Patients

IBW equation (female)
Equation 27.5.2 IBW for Female Patients

Creatine Clearance C-G Equation
Equation 27.5.3 Creatinine Clearance (Cockcroft-Gault Equation)

Dosing Interval
Equation 27.5.5 Dosing Interval, τ

Maintenance Dose
Equation 27.5.6 Maintenance Dose

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