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Thread: Cellulitis Treatment: Vancomycin Side Effects?

  1. #1

    Cellulitis Treatment: Vancomycin Side Effects?

    Chronic wound in middle finger flared up with MRSA found in wound culture. Immediate surgery followed ER visit. 4 days of vanco IV in hospital. Complained about abdominal bloating and discomfort but Dr insisted on laxatives for constipation. Increased flow of urine filled bladder 5 or more times setting off autonomic dysreflexia. Bladder filled to 800- 1200 ml (normally 350). BP spikes to 185/154 to over 200/?.

    Staff didn't understand AD. Gave them my AD Alert card.

    home now on 3rd day of vanco. Belly swollen, hurts, back spasms, chest hurts, ears ring and hurt, feel like I'm crawling out of my skin.

    Because of weekend, I can't find out what to do. IV Infusion pharmacist said dosage is too high because of SCI, that longer duration should be used and less concentration. Said dosage could be toxic and result in kidney problems.

    Home health nurse contacted on call primary doc who advises not to change vanco dosage, to go to ER for hypertension because of chest pain. I know it's not that, BP only goes up when bladder fills.

    Hospital UCSD didn't give me any numbers to call.

    I dont want want to take more vanco if it's harmful and go through these side effects, but don't want to jeopardize the infection either.

    any advice. Thank you.

  2. #2
    1. J Spinal Cord Med. 1995 Oct;18(4):233-5.

    Vancomycin pharmacokinetics in spinal cord injured patients: a comparison with
    age-matched, able-bodied controls.

    Lavezo LA(1), Davis RL.

    Author information:
    (1)Pharmacy Department, Veterans Affairs Medical Center, Albuquerque, NM 87108,
    USA.

    To compare the pharmacokinetics of vancomycin in chronic spinal cord injured
    patients and hospitalized, age-matched, able-bodied controls, we evaluated 14
    spinal cord injured patients and 14 controls. Pharmacokinetic parameters of total
    body clearance (CL), distribution volume (V), elimination rate constant (k) and
    elimination half-life (t1/2) were calculated from two steady-state vancomycin
    serum concentrations by the method of Sawchuk and Zaske. Demographic data such as
    age, ideal body weight (IBW), total body weight (TBW) and serum creatinine at
    start of therapy (SCr), pharmacokinetic parameters and predicted dosages to
    achieve specific peak (30 mcg/ml) and through concentrations (5-10 mcg/ml) were
    calculated for both groups. Statistical comparisons were made using a two sample,
    Student's t-test. Demographic data between groups differed only in mean serum
    creatinine (p = 0.04). There were no statistically significant differences in
    mean pharmacokinetic parameters of CL and V or mean predicted dosages. Mean
    elimination rate constant was significantly smaller and mean elimination
    half-life was significantly longer in spinal cord injured patients (p = 0.02 and
    p = 0.04, respectively). The longer dosing interval predicted in spinal cord
    injured patients trended toward statistical significance (p = 0.10).

    We conclude
    that with chronic spinal cord injury, 1) the elimination half-life of vancomycin
    is increased and these patients may require longer dosing intervals and 2)
    distribution volume and predicted vancomycin doses are unaltered compared with
    controls.


    PMID: 8591068 [Indexed for MEDLINE]

  3. #3
    Arch Phys Med Rehabil. 1997 May;78(5):459-62.

    A simple method for administering vancomycin in the spinal cord injured population.

    Griver AR1, Prince RA, Darouiche RO.

    Author information


    Abstract

    OBJECTIVE:

    To examine the applicability in patients with spinal cord injury (SCI) of a modified version of the commonly used Lake and Peterson dosing regimen for vancomycin.

    DESIGN:

    Nonrandomized, prospective clinical trial with a historical control.

    SETTING:

    Spinal cord injury unit at a Veterans Affairs Medical Center.

    PATIENTS:

    Hospitalized patients with a history of SCI at least 6 months earlier and an estimated creatinine clearance of > or = 15 mL/min who required vancomycin therapy. The experimental group consisted of 15 evaluable patients, 8 with tetraplegia and 7 with paraplegia.

    INTERVENTION:

    Vancomycin regimens were initiated using a modified version of the guidelines of Lake and Peterson.

    MAIN OUTCOME MEASURE:

    After 4 to 8 doses, peak vancomycin concentrations in serum were obtained 15 minutes after a 1-hour infusion, and trough concentrations were drawn within 30 minutes of the next scheduled dose.

    RESULTS:

    Only 3 of 15 (20%) patients in the experimental group required a single adjustment in the dosing interval to achieve the targeted serum vancomycin concentrations. The proportion of patients who required dosing modification was significantly lower in the experimental group than in a group of 16 SCI control patients who received vancomycin according to the dosing recommendations in the drug insert (20% vs 75%, respectively; p = .002).

    CONCLUSION:

    These results support the need for tailored vancomycin dosing in the SCI population and the efficacy of this simple method of administering vancomycin in achieving desirable concentrations of vancomycin in the serum of SCI patients.


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