Vancomycin Pharmacokinetics and Pharmacodynamics

Questions provided by Michele Splinter, Pharm.D.

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A. 55 y/o, 91.8 kg, 74 in. male patient is diagnosed with osteomyelitis following projectile penetration of his left tibia when mowing the yard. The organism has been identified as methicillin resistant Staphylococcus aureus. Vancomycin therapy was begun on 9/24 at 10AM with dosing of 1500 mg IV once over 1.5 hour. The vancomycin MIC is 1.7 mg/L. Serum concentrations were obtained after the patient's first dose. The patient's laboratory values and vancomycin dosing history are:

Laboratory Values
Serum creatinine (Scr)1.2mg/dL
Blood urea nitrogen (BUN)15mg/dL
White blood cells (WBC)12.7K cells/mm3
Maximum temperature (Tmax)38.0°C

Vancomycin Dosing History
DateTimeDoseInfusion DurationSerum Vancomycin Concentration
9/2410001500 mg1.5 hour 
9/241205  24.3 - Post dose peak
9/242150  9.2 - Pre dose trough

With these data calculate kel, t1/2, Vd, CL, Cpmax and Cpmin.

B. Calculate a reasonable dosing interval (nearest 12 hr) and maintenance dose (nearest 250 mg), infusion duration (to the nearest 15 minutes) to achieve a peak serum concentration (Cpmaxss) of 55 mg/L and a trough concentration (Cpminss) of 10 mg/L. Calculate 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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