Pharmacokinetics of vancomycin in adult cancer patients

Abstract

Background and Objectives. Gram-positive infections are prevalent among cancer patients and vancomycin therapy is often initiated empirically. A typical vancomycin pharmacokinetics is observed in such patients. The aim of the study was to evaluate the pharmacokinetics of vancomycin in this patient population and compare it to that of normal population. Method and Results. The pharmacokinetics of vancomycin was examined retrospectively in two groups of patients — 18 cancer patients (age 43.4 ± 22.1 years) and 13 patients without cancer (age 48.5 ± 20.2 years). Following the administration of intermittent intravenous infusion of 15 mg/kg of vancomycin, peak and trough vancomycin serum concentration were determined after the third dose or at steady state as per standard of care. Vancomycin data were analyzed according to a one-compartment open model. Pharmacokinetic parameters such as clearance (CL), volume of distribution (Vd), and K elimination (ke) were calculated. Both Vd and CL were significantly higher in the cancer group (Mean Vd was 70 ± 45 L in the cancer group and 31.1 ± 8.3 L in the noncancer group, p-value 0.002; CL mean was 110.1 ± 42 mL/min in the cancer group and 71.2 ± 22.2 mL/min in the noncancer group, p-value 0.005). There was no significant difference in K elimination and half-life (t1/2). Conclusion. Cancer patients may require higher than usual dosing regimens to ensure optimal therapeutic concentrations, since vancomycin CL and Vd is significantly higher in these patients, a dosing schedule as high as 60 mg/kg/day may be needed for cancer patients.