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![Vancomycin
28
• Manufacturer’s labeling:
Usual dose: 500 mg every 6 hours or 1,000 mg
every 12 hours
• Alternate recommendations*:
15 to 20 mg/kg/dose every 8 to 12 hours
*(ASHP/IDSA/SIDP [Rybak, 2009]);](https://image.slidesharecdn.com/56c832d5-c49a-4fa8-a59e-00a64bb3a6b5-160209184624/75/Antibiotics-1-28-2048.jpg)
![Vancomycin
29
• *Complicated infections in seriously ill
patients:
A loading dose of 25 to 30 mg/kg (based on
actual body weight)
*(ASHP/IDSA/SIDP [Rybak, 2009]);](https://image.slidesharecdn.com/56c832d5-c49a-4fa8-a59e-00a64bb3a6b5-160209184624/75/Antibiotics-1-29-2048.jpg)
More Related Content
Antibiotics 1
- 1. Mohammed Adel, B.Sc.,PharmD Clinical Pharmacy Department Al-Ahrar General Hospital Antibiotics: Optimization of use & excellence of outcome 1
- 2. • Principles ofantibiotic use • Time dependent activity • Conc. Dependent activity • Dual activity • Indications for prophylaxis Content 2
- 3. • Vancomycin: • Mechanismof action • Indications • Dosing • ADR Content 3
- 4. Principles of antibioticuse 4 Drug Dose Delivery Duration De-escalation
- 5. Principles of antibioticuse • Prevent infectionProphylactic • Abort infectionPreemptive • Initial control of infectionEmpiric • Cure infection of know etiology Definitive 5
- 6. Principles of antibioticuse • Prevent endocarditis • Surgical prophylaxis Prophylactic • Against cytomegalovirus in immune suppressed Pts Preemptive • CAP / HAP / VAPEmpiric • Known etiologic organism & susceptibility Definitive 6 Pt= Patient CAP= Community Acquired pneumonia HAP= Hospital Acquired pneumonia VAP=Ventilator Acquired pneumonia
- 7. Principles of antibioticuse 7 • Initiate appropriate Abx therapy ASAP Every 1 Hr delay = 8% increase in mortality • Be aware of the site of infection Local control Treating most likely organism ABX= antibiotics ASAP= as soon as possible
- 8. Principles of antibioticuse 8 • Possibility of resistance Abx exposure Known resistant colonization Exposure to heath care facilities Local Abx resistance pattern • Host factor: Allergy Organ function status ABX= antibiotics
- 9. Principles of antibioticuse 9 • Severity of illness Using IV vs PO Choosing upper end of the dosing range Consider loading dose Consider combination therapy ABX= antibiotics IV= Intravenous PO= Oral route
- 10. Principles of antibioticuse 10 • Treat infection… not colonization • Cultures before Abx Without delay • Administer the 1st dose ASAP • Monitor response to your Abx therapy After 48-72 Hrs Take routine Abx time out ABX= antibiotics ASAP= as soon as possible
- 11. Principles of antibioticuse 11 • What is time out?? – Time out is the check point at which the physician should answer these questions: Does this patient have an infection that will respond to antibiotics? Is the patient on the right antibiotic(s), dose, and route of administration?
- 12. Principles of antibioticuse 12 • What is time out?? – Time out is the check point at which the physician should answer these questions: Can a more targeted antibiotic be used to treat the infection? How long should the patient receive the antibiotic(s)?
- 13. Principles of antibioticuse 13 • Re-evaluation of therapy depends on: – Clinical response – Microbiologic data Organism ID Local anti-biogram Isolate susceptibility
- 14. Principles of antibioticuse 14 Chk your Pt -ve Culture No change Worse Improved +ve Culture Optimize
- 15. Principles of antibioticuse 15 Improving pt Re-evaluate the dose Evaluate Adverse effects 1- If culture +ve: refine your regimen 2- If culture –ve: decide the duration
- 16. Principles of antibioticuse 16 Refining / de- escalating regimen • Resolve bug drug mismatch • Plan the likely duration • De-escalation: • Narrowing spectrum • Eliminate redundancies • Consider PO route
- 17. Time dependent activity 17 •Antibiotic needs more time to achieve 99.9% kill target • Serum conc. Is not important • Observed in: – β-lactams – Macrolides – Clindamycin – Glycopeptides • How to optimize time dependent effect?
- 18.
- 19. Concentration dependent activity 19 •Antibiotic needs higher concentration to achieve 99.9% kill target • Time of exposure Is not important • Observed in: – Aminoglycosides – Fluoroquinolones – Daptomycin – Metronidazole • How to optimize conc. dependent effect?
- 20. Concentration dependent activity 20 Thisis Genta ! :D
- 21. Concentration dependent activity 21 Whichkill better?
- 22. Mixed pattern activity 22 •Fluoroquinolones differs in it’s pattern • It uses AUC24:MIC ratio – For gm -ve ---< 125 for Cipro/Levo – For gm +ve ---< 30 for Levo
- 23.
- 24. Indications for antibioticprophylaxis 24 • Before dental procedures against IE • Before surgical procedures • Before GI endoscopy • For SBP • For recurrent UTI IE= infective endocarditis GI= Gastro-intestinal SBP= Spontaneous Bacterial Pretonitis UTI= Urinary tract infection
- 25. Vancomycin 25 • Glycopeptide antibiotic •Mostly effective against Gm+ve Bacteria • Always reserved for complicated or multidrug resistant infections • Characterized with mixed time/concentration killing pattern
- 26.
- 27. Vancomycin 27 • Against MRSAin HAP/VAP • For bacterial IE • GI chemosterlization (PO) • Prosthetic joint infection • CDAD HAP= Hospital Acquired Pneumonia VAP= Ventilator Acquired Pneumonia IE=Infective Endocarditis GI=Gastrointestinal CDAD=C.difficile-Associated Diarrhea
- 28. Vancomycin 28 • Manufacturer’s labeling: Usualdose: 500 mg every 6 hours or 1,000 mg every 12 hours • Alternate recommendations*: 15 to 20 mg/kg/dose every 8 to 12 hours *(ASHP/IDSA/SIDP [Rybak, 2009]);
- 29. Vancomycin 29 • *Complicated infectionsin seriously ill patients: A loading dose of 25 to 30 mg/kg (based on actual body weight) *(ASHP/IDSA/SIDP [Rybak, 2009]);
- 30. Vancomycin 30 • Injection: – Morethan10%: Cardiovascular: Hypotension accompanied by flushing Dermatologic: Erythematous rash on face and upper body (red neck or red man syndrome - infusion rate related)
- 31. Vancomycin 31 • Injection: – From1% to 10%: Central nervous system: Chills, drug fever Dermatologic: Rash Hematologic: Eosinophilia, reversible neutropenia Local: Phlebitis
- 32. Vancomycin 32 • Oral: – Morethan10%: Gastrointestinal: Abdominal pain, bad taste (with oral solution), nausea
- 33.
Editor's Notes
- #8 Appropriate means that organism is susciptible to it Every hr
- #9 Colonization with resistant organisms
- #10 Colonization with resistant organisms
- #11 Colonization with resistant organisms
- #12 Colonization with resistant organisms
- #13 Colonization with resistant organisms
- #14 Colonization with resistant organisms
- #15 Colonization with resistant organisms
- #16 Colonization with resistant organisms
- #17 Colonization with resistant organisms
- #18 Bacteriostatic when MIC is 35-45% of cephalosporin 30% penicillin 40% carbepenims --- but if exposure become cidal when to mic 60-70% cephalosporins 50% peniocillins- 40% carbepenims --------------------- to optimize time dependent activity: increase dose or frequency or duration of infusion
- #19 Bacteriostatic when MIC is 35-45% of cephalosporin 30% penicillin 40% carbepenims --- but if exposure become cidal when to mic 60-70% cephalosporins 50% peniocillins- 40% carbepenims --------------------- to optimize time dependent activity: increase dose or frequency or duration of infusion
- #20 Genta Q8hrs better Q24hrs Cmax:MIC ration 8:10
- #21 Genta Q8hrs better Q24hrs Cmax:MIC ration 8:10
- #22 Genta Q8hrs better Q24hrs Cmax:MIC ration 8:10
- #24 Bacteriostatic when MIC is 35-45% of cephalosporin 30% penicillin 40% carbepenims --- but if exposure become cidal when to mic 60-70% cephalosporins 50% peniocillins- 40% carbepenims --------------------- to optimize time dependent activity: increase dose or frequency or duration of infusion