Attention to age: Similar dosing regimens lead to different vancomycin levels among older and younger patients

Dafna Yahav, Maria Abbas, Laila Nassar, Alia Ghrayeb, Daniel Shepshelovich, Daniel Kurnik, Leonard Leibovici, Mical Paul

Research output: Contribution to journalArticlepeer-review

Abstract

Background: little is known on the clinical implications of vancomycin trough levels among older patients. Objective: to evaluate the association between vancomycin levels and outcomes among older versus younger patients. Design: retrospective study. Subjects: patients aged 18-64 and ≥65 years treated with vancomycin for documented methicillin resistant Staphylococcus aureus (MRSA) infections. Methods: we compared the effectiveness and toxicity of vancomycin according to trough levels in older versus younger patients. Subgroup analysis of patients with glomerular filtration rate (GFR) > 60 ml/min/1.73 m2 was performed. Results: we included 181 patients aged ≥65 years and 104 younger patients. Mean age in the older group was 76.9 ± 8 years versus 50.9 ± 12.4 in the younger group. Vancomycin trough levels and 24-hours area under the curve to minimal inhibitory concentrations (AUC/MIC) were significantly higher in older patients who were also significantly more likely to achieve trough levels of ≥15 mg/l within 4 days, (98/181 (54.1%) vs. 38/104 (36.5%) in younger patients, P = 0.004). Results were similar among patients with GFR > 60. Thirty-day mortality was significantly higher in older (74/181, 40.9% vs. 13/104, 12.5%, respectively, P < 0.001). There was no association between vancomycin trough levels and mortality among older patients. No significant differences were demonstrated in clinical or microbiological success or nephrotoxicity. Conclusions: applying uniform dosing recommendations across age groups among adults with MRSA infections results in higher vancomycin levels and AUC/MIC in older versus younger patients. Yet, mortality rates remain higher among older adults. Prospective studies are needed to define the optimal approach for using this drug in older patients.

Original languageEnglish
Pages (from-to)26-31
Number of pages6
JournalAge and Ageing
Volume49
Issue number1
DOIs
StatePublished - 1 Dec 2019

Keywords

  • infection
  • methicillin resistant Staphylococcus aureus (MRSA)
  • older people
  • trough levels
  • vancomycin

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