Ann Thorac Surg 2006;81:789
© 2006 The Society of Thoracic Surgeons
Correspondence
Is Re-Dosing of Vancomycin Necessary?
Jamal H. Khan, MD,
Elaine A. Davis, RN, EdD
Department of Cardiovascular Medicine, Charleston Area Medical Center, 3200 MacCorkle Ave, SE, Charleston, WV 25304
(Email: jamal.khan{at}camc.org).
To the Editor:
Because the re-dosing of antibiotics during heart operations after 4 hours is the usual practice, it seems that the same procedure is utilized for vancomycin even though it may be 1 or 2 hours later. However there is enough evidence that vancomycin levels remain therapeutic even through longer operations, and repeating the dose of vancomycin before its normal time is unwarranted. We conducted a study on 10 patients who were candidates to receive vancomycin and who had normal renal function (creatinine, 0.6 to 1.1; average, 0.84) to determine levels of vancomycin in blood through the course of an operation. With institutional review board approval, and after obtaining informed consent from the patients, vancomycin levels were drawn at incision, 15 minutes on bypass, at skin closure, and 12 hours after the first dose. All patients were done on cardiopulmonary bypass. Patients received vancomycin (15 mg/kg) 1 to 2 hours before incision. Pump times (33 to 208 minutes; average, 118 minutes) and urine output on pump (150 to 1,635 cc; average, 911 cc) were recorded. The results were as follows: (1) at incision: 25 to 66 mcg/mL; average, 43.6; standard deviation, 10; (2) at 15 minutes: 10 to 25 mcg/mL; average, 17; standard deviation, 4.2; (3) at skin closure: 9 to 18 mcg/mL, average, 13.3; standard deviation, 2.7; and (4) at 12 hours: 5 to 7 mcg/mL; average, 6.2; standard deviation, 1.1.
The therapeutic level for vancomycin is 5 to 40 mcg/mL. Other reports corroborate these findings. It seems that there is no need to repeat vancomycin before its normal 12-hour dosing regimen [1–3].
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References
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- Vuorisalo S, Pokela R, Syrjala H. Is single dose prophylaxis sufficient for coronary artery bypass surgery? An analysis of peri- and postoperative serum cefuroxime and vancomycin levels J Hosp Infec 1997;37:237-247.[Medline]
- Maki DG, Bohn MJ, Stolz SM, Kroncke GM, Acher CW, Myerowitz PD. J Thorac Cardiovasc Surg 1992;104:1423-1434.[Abstract]
- Austin TW, Leake J, Coles JC, Goldbach MM. Vancomycin blood levels during cardiac bypass surgery Can J Surg 1981;24:423-425.[Medline]
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