Attainment of therapeutic vancomycin level within the first 24 h: Authors' response

Excerpt

In sepsis, time is life. However, time is not the only variable of the complex equation of antibiotic therapy; the dose of antibiotic administered needs to be adequate. Subtherapeutic antibiotic concentrations potentially lead to decreased microbial killing, treatment failure, and emergence of resistance and/or increased mortality. Early therapeutic drug monitoring and timely dose optimization, ideally during the first 24 h, minimize the likelihood of subtherapeutic antibiotic concentrations and ineffective antibiotic therapy. Vancomycin remains a first-line option for the treatment of methicillin-resistant Staphylococcus aureus and other resistant Gram-positive bacteria. Of note, vancomycin is one of the antibiotics with the highest likelihood of under dosing [1]. Continuous infusion (CI), after adequate loading dose (LD), seems to have pharmacological advantages in the critically ill and enables more consistent achievement of therapeutic exposures. …