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									                Pharmacokinetics of Vancomycin in Adult
                          Oncology Patients
                                        Hadeel Al-Kofide MS.c; Iman Zaghloul PhD; and Lamya Al-Naim PharmD
                                                Department of Clinical Pharmacy, College of Pharmacy. King Saud University

                                                                                                                                            Results
                      Introduction                                            Table I: Patients’ Demographic Data                                    Table III: Vancomycin Regimen
                                                                                                                                                     Data presented as Mean ± Standard Deviation
                                                                                                                                                                                                                                              Discussion
                                                                              Data presented as Mean ± Standard Deviation
 Gram-positive infections are prevalent among cancer patients, and                                                    Non-                                                                    Non-                     There was about    80% increase in vancomycin clearance in
  Methicillin-resistance Staphylcoccus aureus (MRSA) account for up                         Cancer                                     P-                           Cancer                                    P-         patients with cancer compared to literature on general population
  to 50% of S.aureus infection                                              Characteristics                            Cancer                       Characteristics                            Cancer
 Vancomycin is an integral part of the management of infections in                         Group                                      value                        Group                                     value     When comparing with our control there was a 50% increase in
                                                                                                                       Group                                                                   Group                     the clearance
  cancer patients when MRSA is suspected due to the emergence of
                                                                                                                                                                                                                        Vancomycin clearance in the control Saudi group was increased
  such resistant organism & the absence of an alternative in these          Age                     43.4 ± 22.1        48.5 ± 20.2     0.526        Dose mg                 986.1 ± 159.8 1000 ± 353.6 0.884             by 32% when compared to published literature
  patients
 Studies have shown sub-therapeutic levels of vancomycin in such                                                                                                                                                       Vancomycin dose required for such patients was double the
                                                                            Height, cm              161.1 ± 11.7       164.9 ± 10.1 0.349
  population. Therefore, higher dosages have been proposed to ensure                                                                                Frequency hr            13.3 ± 3.9         11.5 ± 1.7     0.129     usual dose (about 60 mg/kg/day)
  optimal drug concentrations                                               TBW, kg                 66.8 ± 17.1        68.9 ± 14       0.714                                                                            Critical characteristics of patients with cancer such as diagnosis,
                                                                                                                                                                                                                        & the existence of neutropenia among other clinical parameters
                                                                                                                                                    Peak mg/L               19.1 ± 6.3         27.2 ± 10.9    0.027
                                                                                                                                                                                                                        analyzed, had no significant correlation with or effect
                                                                            IBW, kg                 55.9 ± 12.5        58.4 ± 10.6     0.56
                        Objectives                                                                                                                  Trough mg/L             7.1 ± 5.5          8.5 ± 4.5      0.458
                                                                                                                                                                                                                        on vancomycin disposition
                                                                                                                                                                                                                        Except for creatinine clearance which would be expected in a
                                                                            BSA                     1.7 ± 0.25         1.7 ± 0.19      0.5
 The aim of the study is to evaluate the effects of certain clinical                                                                                                                                                   drug eliminated mainly through renal excretion.
  factors on the kinetics of this drug in cancer patients and to find       Table II: Patients’ Clinical Data,                                      Table IV: Vancomycin Pharmacokinetic Parameters
  potential predictive factors for dosage individualization. In addition,   Data presented as Mean ± Standard Deviation                             Data presented as Mean ± Standard Deviation
  to study its kinetics in Saudi non-cancer patients to be used for
  comparison with previous literature.                                                                        Non-                                                                        Non-
                                                                                                       Cancer                          P-           PK                  Cancer
                                                                            Characteristics                   Cancer                                                                      Cancer             P-value
                                                                                                       Group                           value        parameter           Group
                                                                                                              Group                                                                       Group
                          Methods                                                                                                                                                                                                           Conclusions
                                                                            Albumin, g/L               26.1 ± 6.0 29.5 ± 6.7           0.155        K, hrˉ¹             0.14 ± 0.1        0.14 ± 3.9         0.947
 Study Design: retrospective study                                                                                                                                                                                      Standard dosage regimens of vancomycin, in oncology patients,
                                                                            Total Protein, g/L         62.4 ± 6.2 66.1 ± 9.5           0.206                                                                             continue to be used although they may often be suboptimal owing
 Study Setting and Time: the data were collected in King Khalid                                                                                     t1/2, hr            8.6 ± 7.1         5.4 ± 1.9          0.111
  University Hospital (KKUH) for the year 2005                                                                                                                                                                           to the greater Cl & Vd found in this target population
                                                                            Serum Creatinine,                                                                                                                           Cancer patients may require higher than usual dosing regimens to
 Inclusion Criteria: all adult inpatients on vancomycin with the                                       64.2 ± 21       83.1 ± 35.2     0.073
                                                                            umol/L                                                                                      70 ± 45           31.1 ± 8.3                     ensure optimal therapeutic concentrations
  availability of necessary data as vancomycin peak levels                                                                                          V d, L                                                   0.002
 Exclusion Criteria: patients with acute or chronic renal failure and                                                                                                                                                   TDM of vancomycin is strongly recommended in this population
                                                                            CrCl, ml/min               105.5 ± 62 87.2 ± 27.5          0.331                                                                            More care should be taken when giving vancomycin to cancer
  lack of required information                                                                                                                      Cl, ml/min          110.1 ± 42        71.2 ± 22.2        0.005
 A total of 260 adult inpatients admitted in KKUH for the year 2005                                                                                                                                                     patients due to their high clearance values.
  on vancomycin were screened for eligibility                                                                               1.2
 From those patients, 31 were chosen for analysis others were
                                                                                                                                                                                  1.15
  excluded due to lack of necessary data as vancomycin peak levels                                                           1                                   1.08
  and acute or chronic renal failure                                                                                                                                 0.98               1.01
 Two groups of patients were assigned, 18 cancer & 13 non-cancer                                                                                 0.86
                                                                                                                            0.8
  patients                                                                      Figure I: Comparison with
 Measurement of the peak & trough levels were conducted after the                                                                         0.7                                                         Cl/CrCl
  third dose of the initial dosing regimen & Vancomycin
                                                                                        Literature
                                                                              HM, Haematological Malignancies. Cl,
                                                                                                                            0.6     0.65                                                                                              Acknowledgments
  pharmacokinetic parameters were calculated                                                                                                                                                           Vd/TBW
                                                                              Clearance. CrCl, Creatinine Clearance.        0.4                          0.47
 The data were coded & entered in to a Statistical Package for Social        Vd, Volume of Distribution. TBW, Total                                                                                                   We would like to thank the departments of oncology, medical
  Sciences (SPSS)                                                                         Body Weight                                                                                                                  records and pharmacy staff at KKUH who helped us during our
 Pharmacokinetic calculation was conducted on Excel program                                                                0.2
                                                                                                                                                                                                                       investigation.
 Independent sample t test was done to compare values between study
  groups; with a statistical significance level < 0.05                                                                       0
                                                                                                                                   General       Non-Cancer Literature on         Cancer
 Correlation between different parameters was done using Pearson
  correlation.                                                                                                                    Population       Group         HM               Group

								
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