Vancomycin dosage requirements among pediatric intensive care unit patients with normal renal function

Area of Science:

• Pharmacology
• Pediatric Critical Care
• Infectious Diseases

Background:

• Vancomycin is crucial for treating serious Gram-positive infections, especially in pediatric intensive care units (PICU).
• Achieving therapeutic vancomycin serum concentrations is vital for efficacy and minimizing resistance.
• Optimal dosing in critically ill children, particularly those with normal renal function, requires careful consideration.

Purpose of the Study:

• To establish an effective vancomycin dosage regimen for pediatric intensive care unit (PICU) patients with normal renal function.
• To achieve target vancomycin peak and trough serum concentrations in this patient population.
• To assess the predictability of vancomycin peak concentrations based on trough concentrations.

Main Methods:

• Retrospective review of medical records for 76 pediatric intensive care unit (PICU) patients who received vancomycin.
• Exclusion of patients with renal dysfunction or inadequate concentration data.
• Analysis of vancomycin dosing history, peak, and trough serum concentrations.

Main Results:

• Initial mean vancomycin dose was 47 mg/kg/day, yielding mean peak/trough levels of 19/6 microg/mL.
• Final mean dose increased to 60 mg/kg/day, resulting in mean peak/trough levels of 26/8 microg/mL.
• Vancomycin trough concentrations >5 microg/mL strongly predicted peak concentrations >20 microg/mL (P > .0001).

Conclusions:

• Pediatric intensive care unit (PICU) patients require higher vancomycin doses than typically prescribed.
• A recommended initial dosage regimen of 60 mg/kg/day divided every 8 hours for patients without renal impairment.
• Vancomycin trough concentrations are reliable predictors of peak concentrations, potentially simplifying therapeutic drug monitoring.