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Vancomycin elimination in human infants with intrauterine growth retardation

Daniel A C Frattarelli1, Hakan Ergun, Marianne Lulic-Botica

  • 1Division of Clinical Pharmacology, Children's Hospital of Michigan, Detroit, MI, USA. dfrattar@med.wayne.edu

The Pediatric Infectious Disease Journal
|November 12, 2005
PubMed

Insights

Intrauterine growth retardation (IUGR) in newborns may slow vancomycin elimination, particularly in the first month of life. This suggests tailored dosing for small for gestational age (SGA) infants may be necessary.

Area of Science:

  • Neonatal Pharmacology
  • Pediatric Nephrology
  • Pharmacokinetics

Background:

  • Intrauterine growth retardation (IUGR) reduces organ mass and function in newborns.
  • Impaired kidney and liver function in IUGR infants may affect drug metabolism and elimination.
  • Vancomycin is a critical antibiotic for treating serious infections in neonates.

Purpose of the Study:

  • To test if IUGR leads to prolonged renal elimination of vancomycin in newborns.
  • To compare vancomycin pharmacokinetics between small for gestational age (SGA) and appropriate for gestational age (AGA) infants.

Main Methods:

  • Matched cohort study comparing SGA (n=20) and AGA (n=123) newborns.
  • Calculated vancomycin clearance (Cl), volume of distribution (Vd), and half-life (t(1/2)) from serum concentrations.
  • Analyzed pharmacokinetic profiles based on age and gestational status.

Main Results:

  • Vancomycin clearance was similar overall but decreased in SGA infants aged 3-4 weeks.
  • Half-life was prolonged in SGA newborns aged 3-4 weeks.
  • Normalized vancomycin volume of distribution was similar between SGA and AGA infants.

Conclusions:

  • Vancomycin elimination differs between SGA and AGA newborns, especially in the first month of life.
  • Differences in vancomycin clearance and half-life normalize after 4 weeks of age or 29 weeks postconceptionally.
  • Specific vancomycin dosing recommendations for SGA neonates may be warranted during the first month of life.
Abstract

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