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Vankomycin

Klassificering: A

Preparat: Vancocin, Vancocin®, Vancomycin "Lederle", Vancomycin Actavis, Vancomycin Dr. Eberth, Vancomycin Hospira, Vancomycin MIP, Vancomycin Mylan, Vancomycin Orion, Vancomycin Sandoz, Vancomycin Strides, Vancomycin Xellia

ATC kod: A07AA09, J01XA01

Substanser: vankomycin, vankomycinhydroklorid

Sammanfattning

Det saknas publicerade kontrollerade studier om skillnader mellan könen avseende effekt för vankomycin.

Små studier har visat att kvinnor har lägre clearance än män, kritiskt sjuka kvinnor var även mer benägna än män att uppnå adekvata vankomycinnivåer inom två dygn efter behandling med viktjusterad laddningsdos och infusion. Koncentrationsbestämning för att undvika över- respektive underbehandling är viktigt hos män och kvinnor.
 
Vår bedömning är att de beskrivna skillnaderna inte motiverar olika dosering eller behandling hos kvinnor och män.

Additional information

Pharmacokinetics and dosing

Pharmacokinetic studies have shown that women have lower clearance than men, varying from 15-25% [1-3]. A small study (26 men, 4 women) showed that women had 34% lower clearance than men, however, since the study included very few women the results might be skewed  [2]. One study also showed that women had higher volume of distribution than men when comparing patients of similar age and body weight. These sex differences appeared to be greater in obese patients [3].

Adequate concentrations of vancomycin in critically ill patients are attained by using a weight-based IV loading dose followed by a continuous IV infusion. A study (154 men, 73 women) showed that female sex was associated with early (<48h) adequate vancomycin levels in critically ill patients (odds ratio 4.2, 95%CI 1.6-10.9) [4]. Comparable results where showed in a similar study in septic patients [5].

Effects

No placebo-controlled studies of sex differences in response to vancomycin have been found. Studies comparing vancomycin and metronidazole in treatment of Clostridium difficileinfection have not shown any sex differences in response [6, 7] or risk of second recurrence [8].

Adverse effects

High doses of vancomycin are associated with increased risk of nephrotoxicity. A multivariate analysis of 165 men and 123 women showed no sex or age differences in the risk (odds ratio 0.99).  The multivariate analysis showed Afro-Americans, patients with heart failure or metastatic disease to have a higher risk [9].

Reproductive health issues

Regarding teratogenic aspects, please consult the Drugs and Birth Defects Database (in Swedish, Janusmed fosterpåverkan).

Försäljning på recept

Vankomycin används främst som infusion (ATC-kod J01XA01), vilket inte förskrivs på recept och därför saknas könsspecifika användningsdata [10]. Något fler kvinnor än män hämtade ut kapslar innehållande vankomycin (ATC-kod A07AA09) på recept i Sverige år 2015, totalt 885 kvinnor och 720 män [11].

Uppdaterat: 2019-02-26

Litteratursökningsdatum: 2016-06-01

Referenser

  1. Chung JY, Jin SJ, Yoon JH, Song YG. Serum cystatin C is a major predictor of vancomycin clearance in a population pharmacokinetic analysis of patients with normal serum creatinine concentrations. J Korean Med Sci. 2013;28:48-54. PubMed
  2. Mangin O, Urien S, Mainardi JL, Fagon JY, Faisy C. Vancomycin pharmacokinetic and pharmacodynamic models for critically ill patients with post-sternotomy mediastinitis. Clin Pharmacokinet. 2014;53:849-61. PubMed
  3. Ducharme MP, Slaughter RL, Edwards DJ. Vancomycin pharmacokinetics in a patient population: effect of age, gender, and body weight. Ther Drug Monit. 1994;16:513-8. PubMed
  4. De Waele JJ, Danneels I, Depuydt P, Decruyenaere J, Bourgeois M, Hoste E. Factors associated with inadequate early vancomycin levels in critically ill patients treated with continuous infusion. Int J Antimicrob Agents. 2013;41:434-8. PubMed
  5. Ocampos-Martinez E, Penaccini L, Scolletta S, Abdelhadii A, Devigili A, Cianferoni S et al. Determinants of early inadequate vancomycin concentrations during continuous infusion in septic patients. Int J Antimicrob Agents. 2012;39:332-7. PubMed
  6. Johnson S, Louie TJ, Gerding DN, Cornely OA, Chasan-Taber S, Fitts D et al. Vancomycin, metronidazole, or tolevamer for Clostridium difficile infection: results from two multinational, randomized, controlled trials. Clin Infect Dis. 2014;59:345-54. PubMed
  7. Mezoff E, Mann EA, Hart KW, Lindsell CJ, Cohen MB. Clostridium difficile infection and treatment in the pediatric inflammatory bowel disease population. J Pediatr Gastroenterol Nutr. 2011;52:437-41. PubMed
  8. Pépin J, Routhier S, Gagnon S, Brazeau I. Management and outcomes of a first recurrence of Clostridium difficile-associated disease in Quebec, Canada. Clin Infect Dis. 2006;42:758-64. PubMed
  9. Bosso JA, Nappi J, Rudisill C, Wellein M, Bookstaver PB, Swindler J et al. Relationship between vancomycin trough concentrations and nephrotoxicity: a prospective multicenter trial. Antimicrob Agents Chemother. 2011;55:5475-9. PubMed
  10. Concise. Stockholm: eHälsomyndigheten. 2015 [cited 2016-06-30.] länk
  11. Läkemedelsstatistik. Stockholm: Socialstyrelsen. 2015 [cited 2016-06-30.] Socialstyrelsens statistikdatabas

Författare: Linnéa Karlsson Lind

Faktagranskat av: Mia von Euler

Godkänt av: Karin Schenck-Gustafsson