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Shi Y, Alexander BT, Avedissian S, Bergman SJ, Cortés-Penfield N. In Outpatients Receiving Parenteral Vancomycin, Dosing Adjustments Produced by Area Under the Curve-Based and Trough-Based Monitoring Differ Only at the Extremes of the Therapeutic Trough Range. Open Forum Infect Dis 2023; 10:ofac696. [PMID: 36751644 PMCID: PMC9898881 DOI: 10.1093/ofid/ofac696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 01/05/2023] [Indexed: 01/09/2023] Open
Abstract
Area under the curve (AUC)-based vancomycin dosing reduces nephrotoxicity but is burdensome. Reviewing 115 adults receiving ≥2 weeks of outpatient vancomycin, we found AUC-based and trough-based dose adjustments discordant only for troughs <12 or >16 mg/L. Selective versus universal outpatient AUC calculation would likely offer similar benefit with reduced workload.
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Affiliation(s)
- Yufei Shi
- University of Nebraska Medical Center, College of Pharmacy, Omaha, Nebraska, USA
| | | | - Sean Avedissian
- University of Nebraska Medical Center, College of Pharmacy, Omaha, Nebraska, USA,Antiviral Pharmacology Laboratory, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Scott J Bergman
- University of Nebraska Medical Center, College of Pharmacy, Omaha, Nebraska, USA,Department of Pharmacy, Nebraska Medicine, Omaha, Nebraska, USA
| | - Nicolás Cortés-Penfield
- Correspondence: Nicolás Cortés-Penfield, MD, Division of Infectious Diseases, University of Nebraska Medical Center, 985400 Nebraska Medical Center, MSB 5581, Omaha, NE 68198 (). Bryan Alexander, Nebraska Medicine, 98500 Nebraska Medical Center, Omaha, NE 68198 ()
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Clinical Efficacy and Safety of Vancomycin Continuous Infusion in Patients Treated at Home in an Outpatient Parenteral Antimicrobial Therapy Program. Antibiotics (Basel) 2022; 11:antibiotics11050702. [PMID: 35625346 PMCID: PMC9137986 DOI: 10.3390/antibiotics11050702] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 05/10/2022] [Accepted: 05/21/2022] [Indexed: 11/17/2022] Open
Abstract
Vancomycin is commonly used in outpatient parenteral antimicrobial therapy (OPAT) of Gram-positive infections. Therapeutic drug monitoring and adverse event monitoring pose a challenge. Outcome data of vancomycin in OPAT (vOPAT) are limited. The study aim was to report the safety and efficacy of a structured vOPAT program implemented in the University Hospitals Leuven. The program provides continuous elastomeric infusion of vancomycin at home with biweekly follow-up at the outpatient clinic. Demographics, clinical, biochemical and treatment parameters, target attainment parameters and clinical outcomes were recorded. An e-survey was conducted to assess patient satisfaction. Thirty-five vOPAT episodes in 32 patients were included. During 206 follow-up consultations, 203 plasma concentration measurements were registered with a median vancomycin plasma concentration of 22.5 mg/L (range 6.6–32.0). The majority of concentrations (68.5%) were within the therapeutic range (20.0–25.0 mg/L). Adverse event rates, including drug- (5.7%) and catheter-related (5.7%) events, were low. For 32 vOPAT episodes, a clinical cure rate of 100% was observed. All patients who completed the e-survey were satisfied with their vOPAT course. These findings show that a structured vOPAT program with rigorous follow-up provides safe and effective ambulatory treatment of patients with vancomycin in continuous infusion.
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Al Shareef HJ, Al Harbi A, Alatawi Y, Aljabri A, Al-Ghanmi MA, Alzahrani MS, Algarni MA, Khobrani A, Haseeb A, AlSenani F, Elrggal ME. Evaluate the Effectiveness of Outpatient Parenteral Antimicrobial Therapy (OPAT) Program in Saudi Arabia: A Retrospective Study. Antibiotics (Basel) 2022; 11:antibiotics11040441. [PMID: 35453192 PMCID: PMC9026843 DOI: 10.3390/antibiotics11040441] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 03/14/2022] [Accepted: 03/21/2022] [Indexed: 12/04/2022] Open
Abstract
(1) Background: Outpatient parenteral antibiotic therapy (OPAT) is a well-established and cost-effective measure that improves the efficient use of healthcare resources and increases bed availability. Only limited published data is available to illustrate OPAT implementation and outcomes in Saudi Arabia. The main objective of this study was to evaluate the effectiveness of OPAT in a tertiary center in Saudi Arabia. (2) Methods: In this retrospective study, clinical charts of enrolled patients were reviewed in a tertiary care center from the initial month of November 2017 to March 2020. All admitted patients with a central line and who enrolled in the OPAT of the hospital during this study period were included. The primary outcome was the 30-days readmission rate of OPAT patients. Secondary outcomes were factors associated with OPAT failure. Descriptive analysis of the data was used to express the results. (3) Results: We enrolled 90 patients; 54 (60%) were male; the mean age was 55.16 (±17.7) years old. The mean duration of the antimicrobial treatment was 21.9 (+24.6) days. All patients completed the intended course of therapy. Ertapenem was the most frequently used antimicrobial (43%), followed by vancomycin (11.2%). Urinary tract infections (UTIs) are some of the most common bacterial infections in 25 patients (26.9%), followed by osteomyelitis in 16 patients (17.2%). Extended-spectrum beta-lactamase E.coli was the highest common isolated microorganism (44.9%), followed by methicillin-resistant Staphylococcus aureus MRSA (16.9%). The readmission to the hospital during therapy was required for 12 patients (13.3%). Shifting from hospital care to OPAT care resulted in cost savings of 18 million SAR in the overall assessment period and avoided a total of 1984 patient days of hospitalization. (4) Conclusion: The findings have shown that OPAT therapy was effective with minimum hospital readmissions and therapy complications. OPAT programs can reduce healthcare costs and should be integrated into practice.
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Affiliation(s)
- Haneen J. Al Shareef
- Clinical Pharmacy, King Abdullah Medical City, Makkah 21955, Saudi Arabia; (H.J.A.S.); (M.A.A.-G.); (A.K.)
| | - Adnan Al Harbi
- College of Pharmacy, Umm Al Qura University, Makkah 21955, Saudi Arabia; (A.A.H.); (A.H.); (F.A.)
| | - Yasser Alatawi
- Department of Pharmacy Practice, Faculty of Pharmacy, University of Tabuk, Tabuk 71491, Saudi Arabia;
| | - Ahmed Aljabri
- Department of Pharmacy Practice, Faculty of Pharmacy, King Abdulaziz University, Jeddah 21589, Saudi Arabia;
| | - Mohammed A. Al-Ghanmi
- Clinical Pharmacy, King Abdullah Medical City, Makkah 21955, Saudi Arabia; (H.J.A.S.); (M.A.A.-G.); (A.K.)
| | - Mohammed S. Alzahrani
- Clinical Pharmacy Department, College of Pharmacy, Taif University, Taif 21944, Saudi Arabia; (M.S.A.); (M.A.A.)
| | - Majed Ahmed Algarni
- Clinical Pharmacy Department, College of Pharmacy, Taif University, Taif 21944, Saudi Arabia; (M.S.A.); (M.A.A.)
| | - Attiah Khobrani
- Clinical Pharmacy, King Abdullah Medical City, Makkah 21955, Saudi Arabia; (H.J.A.S.); (M.A.A.-G.); (A.K.)
| | - Abdul Haseeb
- College of Pharmacy, Umm Al Qura University, Makkah 21955, Saudi Arabia; (A.A.H.); (A.H.); (F.A.)
| | - Faisal AlSenani
- College of Pharmacy, Umm Al Qura University, Makkah 21955, Saudi Arabia; (A.A.H.); (A.H.); (F.A.)
| | - Mahmoud E. Elrggal
- College of Pharmacy, Umm Al Qura University, Makkah 21955, Saudi Arabia; (A.A.H.); (A.H.); (F.A.)
- Correspondence: or
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