Content

Therefore, 1 half-life expired during the 22.5-hour time period between the peak concentration and extrapolated trough concentration, and the estimated half-life is 22.5 hours. This information will be used to set the new dosage interval for the patient. The time between the measured steady-state peak and the extrapolated trough concentration is 10.5 hours (the 12-hour dosage interval minus the 1.5-hour combined infusion and waiting time). Because the serum concentration declined by approximately half from the peak concentration to the trough concentration, the vancomycin half-life for this patient is approximately 10.5 hours. Vancomycin steady-state serum concentrations should be measured in 3–5 estimated half-lives.

In this case, the dosage interval would be rounded to 12 hours. The new suggested dose would be 1000 mg every 12 hours to be started 12 hours after the last dose. This patient has poor renal function (CrCl loading dose could be prescribed for this patient and given as the first dose. However, the computed loading dose is less than the maintenance dose, so would not be given.

## Chapter Assessment

If trough-only monitoring is being conducted for a patient, Bayesian computer programs can provide estimates for all vancomycin pharmacokinetic parameters even though only one serum concentration was measured. The nomogram is constructed to produce steady-state vancomycin peak and trough concentrations of 30 μg/mL and 7.5 μg/mL, respectively. A loading dose of 25 mg/kg is given as the first dose, and subsequentmaintenance doses of 19 mg/kg are given according to a dosage interval that varies by the patient’s creatinine clearance. The dosage interval supplied by the nomogram is the time needed for 19 mg/kg of vancomycin to be eliminated from the body. By replacing the amount eliminated over the dosage interval with a maintenance dose of the same magnitude, the same peak and trough vancomycin concentration/ time profile is reproduced after each dose. To illustrate how the nomogram is used, the same patient examples utilized in the previous section will be repeated for this dosage approach. Since the nomogram uses slightly different estimates for volume of distribution and elimination rate constant as well as fixed steady-state peak and trough drug concentrations, differences in suggested doses are expected.

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## Computer Programs

The prescribed maintenance dose would be 1500 mg every 48 hours. The prescribed maintenance dose would be 1000 mg every 72 hours. The prescribed maintenance dose would be 1000 mg every 24 hours. As implied by the name, this technique derives alternate doses by estimating actual pharmacokinetic parameters or surrogates for pharmacokinetic parameters. New dosage intervals are rounded to clinically acceptable values , and the original dose is retained.

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## Linear Pharmacokinetics Method

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