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BROOKE S. CRAWFORD, PHARM.D., is Specialty Practice Pharmacist—Hematology/Oncology, Department of Pharmacy, The Ohio State University Medical Center, Columbus. REBECCA F. LARGEN, PHARM.D., is Clinical Pharmacist Specialist—Internal Medicine; and TED WALTON, PHARM.D., is Clinical Pharmacy Specialist—Renal Medicine, Department of Pharmacy and Drug Information, Grady Health System, Atlanta, GA. JOHN J. DORAN, M.D., is Assistant Professor, Renal Division, School of Medicine, Emory University, Atlanta, and Medical Director, Hemodialysis Unit, Grady Health System.

Address correspondence to Dr. Crawford at the Department of Pharmacy, The Ohio State University Medical Center, 368 Doan Hall, 410 West 10th Avenue, Columbus, OH 43210 (bksorgen{at}hotmail.com).

Purpose. The effectiveness of a once-weekly vancomycin dosing protocol for patients receiving long-term high-flux hemodialysis (HFHD) in the outpatient setting was studied. Methods. Eligible patients were at least 18 years old, required hemodialysis for at least two months before study enrollment, and were not known to have any active infection. All patients received outpatient dialysis at a 1000-bed urban teaching hospital three times per week through a high-flux synthetic dialyzer. All patients received vancomycin 35 mg/kg, rounded to the nearest 250 mg, administered during hemodialysis at a rate of 1 g/hr via an infusion pump and scheduled to end when the hemodialysis session was over. Vancomycin was infused either predialyzer or postdialyzer, and infusion pumps were used in patients who received vancomycin through the postdialyzer access port. Serum vancomycin levels were measured before the third hemodialysis session (study day 8) to evaluate the percentage of patients who maintained therapeutic vancomycin concentrations of 10 µg/mL. Results. No patients achieved a vancomycin concentration of 10 µg/mL on study day 8 (mean serum concentration, 5.1 µg/mL). When patients were separated into two groups based on administration technique, six patients (83%) who received vancomycin predialyzer had undetectable vancomycin levels (<3.5 µg/mL) by study day 8 (n = 6). Patients who received vancomycin postdialyzer maintained a mean serum concentration of 6.4 µg/mL at day 8 (n = 3). Conclusion. A single dose of vancomycin 35 mg/kg administered during HFHD in oliguric patients with end-stage renal disease did not achieve the therapeutic serum concentration necessary for once-weekly dosing. Index terms: Antibiotics; Blood levels; Dialysis; Dosage schedules; Kidney failure; Vancomycin