Design and validation of equation for vancomycin initial dosing in elderly patients
Abstract Elderly patients have unique characteristics that make dosing drugs a necessity in many cases, especially in those excreted by renal function, as in the case of vancomycin. HUGE value is a tool for differentiating the presence or absence of chronic kidney disease in patients older than 70 years. The objective was to obtain an equation based on the HUGE value to predict the initial dose of vancomycin in patients older than 70 years. The equation was designed retrospectively in 70 patients and it was validated in 40 patients in comparison with the PKS® method (Pharmacokinetic System, Abbott) based on creatinine clearance. The submitted equation, HUGE-VAN, was obtained by multiple linear regression:It is recommended to administer vancomycin every 12 hours except that HUGE is greater than 7.34 which is recommended once daily. The values obtained in the validation phase equalize or improve PKS® method. HUGE-VAN considers multiple clinical data and not merely the estimated value of glomerular filtration rate. For this reason, HUGE-VAN is presented like a promising alternative for the vancomycin dosing in patients older than 70 years.
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Martin-Suarez A., García González D, Macías Núñez JF, Ardanuy Albajar R, Calvo Hernández MV. A new Method for Individualized Digoxin Dosing in Elderly Patients. Drugs Aging. 2016 Apr; 33(4):277-84.
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Álvarez-Gregori JA, Robles NR, Mena C, Ardanuy R, Jauregui R, Macias-Nuñez JF. The value of a formula including haematocrit, blood urea and gender (HUGE) as a screening test for chronic renal insufficiency. J Nutr Health Aging. 2011 Jun;15(6):480-4.
Barber KE., Bell AM., Stover KR., and Wagner JL.. Intravenous Vancomycin Dosing in the Elderly: A Focus on Clinical Issues and Practical Application. Drugs Aging. 2016; 33(12): 845-854.
Fernández de Gatta García MM, Martín Suárez A, Martínez Lanao J. Establecimiento de regímenes posológicos en poblaciones Especiales. En: Domenech J./Peraire C./Lanao JM. Tratado general de biofarmacia y farmacocinética. Vol. II. Madrid: Editorial Síntesis; 2013. Capítulo 10.
Flórez J., Armijo J.A, Mediavilla A. Farmacología humana. 5th ed. Barcelona: Elsevier Masson; 2008.
Fontseré Baldellou N., Bonal i Bastons J., Romero González R. Methods for the estimation of the renal function. Med Clin 2007;129:513-8.
Gómez Carracedo A, Baztán Cortés J. Renal function evaluation methods in the elderly: Reliability and clinical implications. Rev Esp Geriatr Gerontol 2009;44:266-72.
INEbase. Ine.es [Internet]. Spain: Spanish Statistical Office; 2017 [actualizado 29 Nov 2016; citado 20 Feb 2017]. Available from: http://www.ine.es/dyngs/INEbase/es/operacion.htm?c=Estadistica_C&cid=1254736176778&menu=ultiDatos&idp=1254735573175
Lacarelle B, et al. Abbott PKS system: a new version for applied pharmacokinetics including Bayesian estimation. Int J Biomed Comput. 1994 Jun:36 (1-2):127-30.
Martin-Suarez A., García González D, Macías Núñez JF, Ardanuy Albajar R, Calvo Hernández MV. A new Method for Individualized Digoxin Dosing in Elderly Patients. Drugs Aging. 2016 Apr; 33(4):277-84.
Turnheim K. When drug therapy gets old: pharmacokinetics and pharmacodynamics in the elderly. Exp. Gerontol. 2003 Aug;38(8):843-53.
Pastor Lozano, A., García González, D., Martín Suárez, A. M., Aradanuy Andujar, R., Macias Nuñez, J. F., & Calvo, M. V. (2018). Design and validation of equation for vancomycin initial dosing in elderly patients. FarmaJournal, 3(1), 111–119. Retrieved from https://revistas.usal.es/cinco/index.php/2445-1355/article/view/17461
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