Background Elimination of vancomycin is primarily by glomerular filtration (80–90%), but the liver may also be involved to a small extent. Chronic consumption of ethanol induces hepatic enzymes and can lead to hepatic damage. Both factors could affect vancomycin elimination. Moreover, the use of drugs of abuse could also affect vancomycin clearance.
Purpose To characterise vancomycin pharmacokinetic parameters in non-cirrhotic alcoholics, patients with alcohol-induced cirrhosis and intravenous drug abusers (IVDAs).
Materials and Methods Retrospective study in the aforementioned patients treated with vancomycin in whom therapeutic drug monitoring (TDM) was performed, between 2009–2012, in a tertiary University Hospital. Clinical and pharmacokinetic reports from TDM (PKS Abbot) were reviewed to obtain demographic characteristics, hepatic/renal surrogates, initial/recommended dosage, steady state (SS) distribution volume (VdSS), clearance (CL), CSSmin and CSSmax. The therapeutic target was 7–12 mg/L for CSSmin. Patients with renal failure (CLcr < 60mL/min) were excluded. Results are shown as a mean±SD (T-test for comparisons with controls).
Results Sixty-five patients were included. Demographic data were similar between the groups. 87.7% were men. Pharmacokinetic data is shown in table 1. As regards pharmacokinetic parameters, significant differences were only observed in CL in cirrhotic patients (#p = 0.02).
Conclusions Vancomycin CL is significantly decreased in cirrhotic patients, probably due to hepatorenal syndrome. Initial dose reduction might be considered. Vancomycin CL tends to be higher in alcoholics and IVDAs. Higher doses could be needed to obtain therapeutic concentrations. Therefore, vancomycin TDM is highly advisable in all these groups of patients.
No conflict of interest.
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