While the PKPD index/target for MRSA with vancomycin is > 400 (some says 350-400 depending on the MIC tests used), what is the PKPD index/s for other isolates like MRCONS/ enterococcus?
And given higher vancomycin MIC breakpoints for MRCONS vs MRSA, does this matter?
PK/PD targets for vancomycin in non-aureus staphylococci and other gram positives haven't been as well studied. However, a recent European study suggests a higher AUC/MIC target of 520 may be needed for CoNS. This is based on a rabbit catheter model ; their in vitro hollow-fiber model required a higher-still AUC/MIC target of 665. The difference between these values may be attributed to the different drug half-lives (they simulated a pediatric half-life of 12 h in their in vitro model ; the half-life in their rabbit model wasn't noted). Additionally, the end points were slightly different (cfu reduction vs. CRP vs. resistant subpopulation).
That said, in the adult population, management is usually straightforward as CoNS frequently seeds from a central line so catheter removal is your primary therapy and without a remaining focus of infection you can typically achieve cure with less vancomycin.
http://www.pubmed.com/26755499/
Hi Helmi,
Look at these data. We found a much lower fAUC/MIC against S. epidermis in the mouse model.
O. Vesga
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