Xu KY, Li D, Hu ZJ, Zhao CC, Bai J, Du WL. Vancomycin dosing in an obese patient with acute renal failure: A case report and review of literature. World J Clin Cases 2022; 10(18): 6218-6226 [PMID: 35949852 DOI: 10.12998/wjcc.v10.i18.6218]
Corresponding Author of This Article
Jing Bai, Associate Chief Pharmacist, Department of Pharmacy, Fourth Hospital of Hebei Medical University, No. 12 Jiankang Road, Chang'an District, Shijiazhuang 050011, Hebei Province, China. baijing619@163.com
Research Domain of This Article
Pharmacology & Pharmacy
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Jun 26, 2022; 10(18): 6218-6226 Published online Jun 26, 2022. doi: 10.12998/wjcc.v10.i18.6218
Vancomycin dosing in an obese patient with acute renal failure: A case report and review of literature
Kun-Yan Xu, Dan Li, Zhen-Jie Hu, Cong-Cong Zhao, Jing Bai, Wen-Li Du
Kun-Yan Xu, Dan Li, Jing Bai, Wen-Li Du, Department of Pharmacy, Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, Hebei Province, China
Zhen-Jie Hu, Cong-Cong Zhao, Department of Intensive Care Unit, Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, Hebei Province, China
Author contributions: Bai J and Du WL conceived the manuscript; Xu KY drafted the manuscript; Li D monitored blood vancomycin concentrations; Hu ZJ was involved in drug therapy; Zhao CC was responsible for the patient.
Supported bythe Hebei Natural Science Foundation of China, No. H2019206614.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jing Bai, Associate Chief Pharmacist, Department of Pharmacy, Fourth Hospital of Hebei Medical University, No. 12 Jiankang Road, Chang'an District, Shijiazhuang 050011, Hebei Province, China. baijing619@163.com
Received: November 23, 2021 Peer-review started: November 23, 2021 First decision: January 11, 2022 Revised: January 19, 2022 Accepted: April 22, 2022 Article in press: April 22, 2022 Published online: June 26, 2022
Abstract
BACKGROUND
Vancomycin is the most commonly used drug for methicillin-resistant Staphylococcus aureus. The empirical clinical doses of vancomycin based on non-obese patients may not be optimal for obese ones.
CASE SUMMARY
This study reports a case of vancomycin dosing adjustment in an obese patient (body mass index 78.4 kg/m2) with necrotizing fasciitis of the scrotum and left lower extremity accompanied with acute renal failure. Dosing adjustment was performed based on literature review and factors that influence pharmacokinetic parameters are analyzed. The results of the blood drug concentration monitoring confirmed the successful application of our dosing adjustment strategy in this obese patient. Total body weight is an important consideration for vancomycin administration in obese patients, which affects the volume of distribution and clearance of vancomycin. The alterations of pharmacokinetic parameters dictate that vancomycin should be dose-adjusted when applied to obese patients. At the same time, the pathophysiological status of patients, such as renal function, which also affects the dose adjustment of the patient, should be considered.
CONCLUSION
Monitoring vancomycin blood levels in obese patients is critical to help adjust the dosing regimen to ensure that vancomycin concentrations are within the effective therapeutic range and to reduce the incidence of renal injury.
Core Tip: We report the medical records of dose adjustment of vancomycin in an obese patient (body weight 240 kg), including the dose adjustment protocol in acute renal injury. This article also reviews the current literature on the application of vancomycin in the obese population and provides recommendations on how to make dose adjustments based on available evidence.
