Vancomycin dosing and monitoring in patients undergoing high-flux haemodialysis in a tertiary hospital.

Infection, predominantly vascular-access related septicemia, is a leading cause of mortality in patients undergoing haemodialysis. Vancomycin is a glycopeptide antibiotic commonly used to treat infections caused by Gram-positive organisms in patients undergoing haemodialysis. The pharmacokinetics of vancomycin in this patient group, with respect to a moderate volume of distribution and low protein-bound fraction, facilitate diffusion through high-flux dialysis membranes. In 2009, key USA guidelines recommended a maintenance serum vancomycin trough concentration range of 15 – 20mg/L for the management of complicated infections to improve clinical outcomes and limit the emergence of resistant organisms.3 Minimal data exists on the ability to achieve these targets in the haemodialysis setting At Flinders Medical Centre (FMC), a 550-bed teaching hospital in Adelaide, dosing practice has been an initial dose of 1g of vancomycin administered intravenously usually during the last hour of haemodialysis, followed by 1g during the next dialysis if the pre-dialysis vancomycin concentration is <15mg/L