How does obesity affect vancomycin dosing?

How does obesity affect vancomycin dosing?

Vancomycin serum concentrations are impacted by increased clearance, increased volume of distribution, and a shorter terminal half-life of this drug in obese patients. In fact, some advocate for more frequent dosing of vancomycin in obese patients to mitigate toxicity and improve efficacy [11].

Is vancomycin dosed based on actual body weight?

The 2011 Infectious Diseases Society of America (IDSA) MRSA guidelines recommend that vancomycin be dosed at 15 to 20 mg/kg/dose (actual body weight) every 8 to 12 hours, not to exceed 2 g per dose, in patients with normal renal function.

What weight should I use for vancomycin?

Load 20 to 35 mg/kg (based on actual body weight, rounded to the nearest 250 mg increment; not to exceed 3000 mg). Within this range, we use a higher dose for critically ill patients; we use a lower dose for patients who are obese and/or are receiving vancomycin via continuous infusion.

Is vancomycin hydrophilic or lipophilic?

Despite being hydrophilic, vancomycin has a wide Vd in critically ill patients (>1.0 L/kg) and >90 % is renally cleared. As such, taking into account the abovementioned pharmacokinetic alterations in both the obese and the critically ill, dosing can be challenging.

How do you calculate adjusted body weight?

Males: IBW = 50 kg + 2.3 kg for each inch over 5 feet. Females: IBW = 45.5 kg + 2.3 kg for each inch over 5 feet. Reference: Devine BJ.

How do you calculate actual body weight?

Remember that BMI = weight(kg)/height2 (meters squared). Next, we will establish an ‘ideal’ BMI based on values in the standard IBW equations: Male: 60 inches – 50kg – BMI= 21.53. Female: 60 inches – 45.5kg – BMI= 19.59.

When do you use adjusted weight for CrCL?

CrCL e CG routine practice: Estimated CrCL using the Cockcroft-Gault equation in which ideal body weight is routine, actual body weight is utilized if a patient weighs less than his/her ideal body weight, and adjusted body weight used when patient,s actual body weight is greater than 130% of ideal body weight.

What nursing considerations are essential when giving vancomycin?

Some considerations for nurses administering vancomycin include ensuring a patent IV line, planning for administration of the preoperative dose as much as two hours before the initial incision is made, and including information about the dose and timing of preoperative vancomycin administration in the surgical time out …

How are antibiotics dosed for obesity?

American consensus guidelines recommend that initial doses for all patients including the obese should be based on TBW and then adjusted based on SVCs (97). Most published data support the use of the Cockcroft-Gault equation with TBW to calculate CrCl and vancomycin clearance in non-obese patients.