<abstract xmlns="http://www.w3.org/1999/xhtml"><sec id="j_abm-2018-0011_s_005_w2aab3b7c10b1b6b1aab1c16b1Aa"><h3>Background</h3><p>To our knowledge, no study reported so far has investigated appropriate vancomycin dosing, which is important for treatment of methicillin-resistant <italic>Staphylococcus aureus</italic> (MRSA) infection in Thai patients of various ages and with varying degrees of renal function.</p></sec><sec id="j_abm-2018-0011_s_006_w2aab3b7c10b1b6b1aab1c16b2Aa"><h3>Objectives</h3><p>To predict vancomycin dosing for MRSA in Thai patients of various ages and with varying degrees of renal functions.</p></sec><sec id="j_abm-2018-0011_s_007_w2aab3b7c10b1b6b1aab1c16b3Aa"><h3>Methods</h3><p>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 (<italic>C</italic><sub>trough</sub>) &lt;20 mg/L of 9 vancomycin dosage regimens for Thai patients stratified by age and renal function.</p></sec><sec id="j_abm-2018-0011_s_008_w2aab3b7c10b1b6b1aab1c16b4Aa"><h3>Results</h3><p>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 (CL<sub>cr</sub>) was calculated using the Cockcroft–Gault equation. Appropriate vancomycin doses for Thai patients infected with MRSA with CL<sub>cr</sub> of &lt;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 <italic>C</italic><sub>trough</sub> of >20 mg/L.</p></sec><sec id="j_abm-2018-0011_s_009_w2aab3b7c10b1b6b1aab1c16b5Aa"><h3>Conclusions</h3><p>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 <italic>C</italic><sub>trough</sub> of &lt;20 mg/L.</p></sec></abstract>

BackgroundTo our knowledge, no study reported so far has investigated appropriate vancomycin dosing, which is important for treatment of methicillin-resistant Staphylococcus aureus (MRSA) infection in Thai patients of various ages and with varying degrees of renal function.ObjectivesTo predict vancomycin dosing for MRSA in Thai patients of various ages and with varying degrees of renal functions.MethodsMonte 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 (Ctrough) <20 mg/L of 9 vancomycin dosage regimens for Thai patients stratified by age and renal function.ResultsVancomycin 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 Ctrough of >20 mg/L.ConclusionsAlthough 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 Ctrough of <20 mg/L.

The use of Monte Carlo simulation to predict vancomycin dosage for methicillin-resistant <italic>Staphylococcus aureus</italic> in Thai patients of various ages and with varying degrees of renal function

Department of Pharmacy, Faculty of Pharmacy

Antibiotic Optimization and Patient Care Project by Pharmaceutical Initiative for Resistant Bacteria and Infectious Diseases Working Group (PIRBIG), Faculty of Pharmacy

Asian Biomedicine

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 License.

The use of Monte Carlo simulation to predict vancomycin dosage for methicillin-resistant  in Thai patients of various ages and with varying degrees of renal function

BackgroundTo our knowledge, no study reported so far has investigated appropriate vancomycin dosing, which is important for treatment of methicillin-resistant Staphylococcus aureus (MRSA) infection in Thai patients of various ages and with varying degrees of renal function.ObjectivesTo predict vancomycin dosing for MRSA in Thai patients of various ages and with varying degrees of renal functions.MethodsMonte 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 (Ctrough) 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 Ctrough of >20 mg/L.ConclusionsAlthough 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 Ctrough of <20 mg/L.

BackgroundTo our knowledge, no study reported so far has investigated appropriate vancomycin dosing, which is important for treatment of methicillin-resistant...

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
Monte Carlo simulation, MRSA, Thai patients, vancomycin dosing

© 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.

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

KeywordsMonte Carlo simulation, MRSA, Thai patients, vancomycin dosing

© 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.

Keywords
Monte Carlo simulation, MRSA, Thai patients, vancomycin dosing