Altered vancomycin dose vs. serum concentration relationship in burn patients

Drug elimination in patients sustaining serious thermal injury may be altered, resulting in an increased clearance and shortened half-life. Nine burn and eight medical/surgical patients with normal renal function were studied prospectively. Doses were adjusted to achieve peak and trough vancomycin serum concentrations within a narrow range. No significant difference between the groups was noted in terms of demographic characteristics, creatinine clearance, or vancomycin serum concentrations. However, the difference in daily dose needed to maintain the specified serum concentrations was significantly greater for burn patients (p less than 0.02). Burn patients also had to be dosed significantly more often than medical/surgical patients to achieve peak and trough vancomycin serum concentrations within the desired range (p less than 0.02). The elimination half-life in burn patients was significantly shorter than that in control patients (p less than 0.001). Because of the unusually high dosage requirements in burn patients, along with their poor predictability, individualization of therapy with vancomycin serum concentrations is recommended to ensure a successful therapeutic outcome.