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Vancomycin dosage in overweight and obese children
Misty Miller1, Jamie L Miller, Tracy M Hagemann
1Department of Pharmacy, Clinical and Administrative Sciences, College of Pharmacy, University of Oklahoma, Oklahoma City, 73117, USA.
Insights
Vancomycin dosing in children showed that while initial doses varied by weight, mg/kg doses did not. Obese children had lower odds of achieving therapeutic vancomycin levels, highlighting the need for optimized dosing strategies.
Area of Science:
- Pediatric pharmacology
- Infectious disease management
- Clinical pharmacokinetics
Background:
- Vancomycin is a critical antibiotic for treating serious Gram-positive infections.
- Optimizing vancomycin dosing is crucial for efficacy and minimizing toxicity, especially in diverse patient populations.
- Overweight and obese pediatric patients present unique pharmacokinetic challenges that may affect drug distribution and clearance.
Purpose of the Study:
- To evaluate vancomycin dosages and therapeutic concentration attainment in overweight and obese children compared to normal-weight children.
- To identify factors influencing the achievement of target vancomycin trough concentrations (5-15 μg/mL).
Main Methods:
- Retrospective analysis of pediatric patients (2-17 years) receiving intravenous vancomycin.
- Stratification of patients into normal-weight and overweight/obese groups.
- Multivariate logistic regression to assess factors associated with achieving therapeutic vancomycin concentrations.
Main Results:
- Initial vancomycin doses (in mg) differed significantly between normal-weight and overweight/obese groups, but not when adjusted for weight (mg/kg).
- Every-eight-hour dosing regimens were associated with increased odds of achieving therapeutic vancomycin concentrations.
- Obese children had decreased odds of achieving therapeutic vancomycin concentrations compared to non-obese children.
Conclusions:
- Standard vancomycin dosing (mg/kg) did not differ significantly between normal-weight and overweight/obese children.
- Every-eight-hour dosing is more likely to achieve target vancomycin levels.
- Obesity is independently associated with a lower likelihood of achieving therapeutic vancomycin trough concentrations, suggesting potential need for weight-adjusted or individualized dosing strategies in this population.
Purpose:
Vancomycin dosages in overweight and obese children were evaluated.
Methods:
This retrospective study evaluated data for children who were age 2-17 years, received i.v. vancomycin, and were admitted to a children's hospital from September 1, 2007, through October 31, 2009. Patients were then stratified into two groups: normal-weight patients and overweight or obese patients. The primary objective was to compare the number of vancomycin regimens between groups with a trough concentration of 5-15 μg/mL. Secondary objectives included a comparison of dosage changes and toxicities. Multivariate, conditional logistic regression was performed to assess the relationship between attaining optimal vancomycin concentrations (5-15 μg/mL) and independent variables.
Results:
Data were collected for 232 courses of vancomycin, representing 187 patients. The mean ± S.D. initial dose for the normal-weight and overweight or obese groups differed significantly (461.3 ± 303.1 mg and 658.4 ± 389.6 mg, respectively; p < 0.01); the milligram-per-kilogram initial vancomycin dose did not. The multivariate analysis revealed that every-eight-hour regimens had increased odds of achieving therapeutic concentrations (p < 0.001), while obese children had decreased odds of achieving therapeutic concentrations (p = 0.037).
Conclusion:
A study of prescribing behavior in one hospital revealed no significant difference in the size of vancomycin doses (in milligrams per kilogram) given to normal-weight children compared with overweight or obese children. Regimens using every-eight-hour dosing were significantly more likely than other regimens to result in a vancomycin trough concentration of 5-15 μg/mL, and regimens for obese children, compared with regimens for nonobese children, were less likely to produce trough concentrations in the same range of 5-15 μg/mL.
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