The use of Monte Carlo simulation to predict vancomycin dosage for methicillin-resistant Staphylococcus aureus in Thai patients of various ages and with varying degrees of renal function

Krairerk Pitaksontayothin; Wichai Santimaleeworagun; Manat Pongchaidecha; Jantana Houngsaitong; Panuwit Srisena

doi:10.1515/abm-2018-0011

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The use of Monte Carlo simulation to predict vancomycin dosage for methicillin-resistant Staphylococcus aureus in Thai patients of various ages and with varying degrees of renal function

Asian Biomedicine

Volume 11 (2017): Issue 4 (August 2017)

By: Krairerk Pitaksontayothin, Wichai Santimaleeworagun, Manat Pongchaidecha, Jantana Houngsaitong and Panuwit Srisena

Open Access

|Mar 2018

Figures & Tables

The cumulative fraction of response (CFR) achieving an area under the curve (AUC)/minimal inhibitory concentration (MIC) >400 and the percentage of trough concentration (C_trough) of vancomycin at steady state for each dosing regimen in simulated patients of various ages. (A) <40 years, (B) 40–60 years, and (C) >60 years. q = quaque or every; l = liter

Table 1

The numbers of methicillin-resistant Staphylococcus aureus (MRSA) clinical isolates according to source of specimens and minimal inhibitory concentration (MIC) distribution (n = 105)

MIC (mg/L)	Source of specimens		Total (%)

	Sputum	Blood
0.5	5	0	5 (4.8)
1	56	1	57 (54.3)
2	41	1	42 (40)
4	1	0	1 (1)

Table 2

The probability of target attainment (PTA) of an area under the curve (AUC)/minimal inhibitory concentration (MIC) > 400 at each MIC according to age of patients

Age(years)	Vancomycin dosing	PTA of each MIC (%)

		0.5	1	2	4
<40	0.75 g every 24 h	92.3	42.0	1.9	0.0
	1 g every 24 h	100	64.6	13.8	0.0
	1.5 g every 24 h	100	92.4	39.9	1.5
	1 g every 12 h	100	100	62.3	14.1
	1.25 g every 12 h	100	100	80.2	27.5
	1 g every 8 h	100	100	92.3	41.2
	1.75 g every 12 h	100	100	99.6	53.3
	2 g every 12 h	100	100	100	63.9
40–60	0.75 g every 24 h	91.9	41.8	1.8	0.0
	1 g every 24 h	100	60.8	13.3	0.0
	1.5 g every 24 h	100	92.7	41.5	1.6
	1 g every 12 h	100	100	63.5	13.9
	1.25 g every 12 h	100	100	80.2	26.8
	1 g every 8 h	100	100	92.6	41.1
	1.75 g every 12 h	100	100	99.7	54.1
	2 g every 12 h	100	100	100	65.5
>60	0.75 g every 24 h	91.3	39.9	1.2	0.0
	1 g every 24 h	100	62.8	13.3	0.0
	1.5 g every 24 h	100	93.2	41.6	1.3
	1 g every 12 h	100	100	62.3	14.2
	1.25 g every 12h	100	100	79.6	28.1
	1 g every 8 h	100	100	92.3	39.8
	1.75 g every 12 h	100	100	99.7	52.0
	2 g every 12 h	100	100	100	64.1

Table 3

The probability of target attainment (PTA) of an area under the curve (AUC)/minimal inhibitory concentration (MIC) >400 at each MIC according to renal function of patients

CL_cr(mL/min)	Vancomycin dosing 0.75 g every 24 h	PTA of each MIC (%)

		0.5	1	2	4
<40	0.75 g every 24 h	100	100	4.7	0.0
	1 g every 24 h	100	100	38.7	0.0
	1.5 g every 24 h	100	100	100	4.1
	1 g every 12 h	100	100	100	40.0
	1.25 g every 12 h	100	100	100	77.3
	1 g every 8 h	100	100	100	100
	1.75 g every 12 h	100	100	100	100
	2 g every 12 h	100	100	100	100
40–60	0.75 g every 24 h	100	14.7	0.0	0.0
	1 g every 24 h	100	86.3	0.0	0.0
	1.5 g every 24 h	100	100	14.4	0.0
	1 g every 12 h	100	100	86.3	0.0
	1.25 g every 12 h	100	100	100	0.0
	1 g every 8 h	100	100	100	14.6
	1.75 g every 12 h	100	100	100	53.1
	2 g every 12 h	100	100	100	87.0
>60–80	0.75 g every 24 h	100	0.0	0.0	0.0
	1 g every 24 h	100	0.0	0.0	0.0
	1.5 g every 24 h	100	100	0.0	0.0
	1 g every 12 h	100	100	0.0	0.0
	1.25 g every 12 h	100	100	59.6	0.0
	1 g every 8 h	100	100	100	0.0
	1.75 g every 12 h	100	100	100	0.0
	2 g every 12 h	100	100	100	0.0
>80	0.75 g every 24 h	31.9	0.0	0.0	0.0
	1 g every 24 h	100.0	0.0	0.0	0.0
	1.5 g every 24 h	100.0	33.1	0.0	0.0
	1 g every 12 h	100.0	100	0.0	0.0
	1.25 g every 12 h	100.0	100	0.0	0.0
	1 g every 8 h	100.0	100	32.5	0.0
	1.75 g every 12 h	100.0	100	97.2	0.0
	2 g every 12 h	100.0	100	100	0.0

[i] CL_cr, creatinine clearance calculated using the Cockcroft–Gault equation

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DOI: https://doi.org/10.1515/abm-2018-0011 | Journal eISSN: 1875-855X | Journal ISSN: 1905-7415

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Language: English

Page range: 379 - 386

Published on: Mar 21, 2018

Published by: Chulalongkorn University

In partnership with: Paradigm Publishing Services

Keywords:

Monte Carlo simulation,

MRSA,

Thai patients,

vancomycin dosing

Related subjects:

Medicine,

Assistive professions, nursing,

Basic medical science,

Basic medical science, other,

Clinical medicine,

Clinical medicine, other

© 2018 Krairerk Pitaksontayothin, Wichai Santimaleeworagun, Manat Pongchaidecha, Jantana Houngsaitong, Panuwit Srisena, published by Chulalongkorn University
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 License.

Volume 11 (2017): Issue 4 (August 2017)

The use of Monte Carlo simulation to predict vancomycin dosage for methicillin-resistant Staphylococcus aureus in Thai patients of various ages and with varying degrees of renal function

Figures & Tables

Figure 1

Figure 2

Table 1

Table 2

Table 3

Paradigm

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