The use of Monte Carlo simulation to predict vancomycin dosage for methicillin-resistant Staphylococcus aureus in Thai patients of various ages and with varying degrees of renal function
Article Category: Brief communication
Published Online: Mar 21, 2018
Page range: 379 - 386
DOI: https://doi.org/10.1515/abm-2018-0011
Keywords
© 2017 Krairerk Pitaksontayothin, Wichai Santimaleeworagun, Manat Pongchaidecha, Jantana Houngsaitong, Panuwit Srisena
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 License.
Background
To our knowledge, no study reported so far has investigated appropriate vancomycin dosing, which is important for treatment of methicillin-resistant
Objectives
To predict vancomycin dosing for MRSA in Thai patients of various ages and with varying degrees of renal functions.
Methods
Monte Carlo simulation and minimal inhibitory concentration (MIC) distribution of MRSA from a hospital in Thailand were used to predict the area under the curve in 24 h/MIC >400 and trough concentration (
Results
Vancomycin dosing at least 2.5 g per day can attain cumulative fraction of response (CFR) of ≥90% in every age group. Vancomycin dosage achieving CFR of ≥90% for simulated patients with creatinine clearance (CLcr) was calculated using the Cockcroft–Gault equation. Appropriate vancomycin doses for Thai patients infected with MRSA with CLcr of <40, 40–60, >60–80, and >80 mL/min were 1.5 g every 24 h, 1.25 g every 12 h, 1 g every 8 h, and 1.75 g every 12 h, respectively. However, more than a half of patients simulated using these regimens have a vancomycin
Conclusions
Although vancomycin doses attaining a CFR of ≥90% can treat MRSA infection effectively, the regimens may cause kidney injury. The regimens have a probability of target attainment of 100%, and most patients can attain