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Updated: May 20, 2026
11:17
Multiplex Therapeutic Drug Monitoring by Isotope-dilution HPLC-MS/MS of Antibiotics in Critical Illnesses
Published on: August 30, 2018
Vancomycin serum concentrations in pediatric oncologic/hematologic intensive care patients
Dáfne Cardoso Bourguignon da Silva1, Gláucia Toribio Finoti Seixas, Orlei Ribeiro de Araujo
1Intensive Care Unit, Grupo de Apoio ao Adolescente e a Criança com Câncer, Instituto de Oncologia Pediátrica, Universidade Federal de São Paulo, Brazil.
Summary
Higher vancomycin doses may be needed for severe staphylococcal infections in pediatric cancer patients. Monitoring the area under the concentration curve/minimum inhibitory concentration (AUC/MIC) ratio is crucial for effective treatment.
Area of Science:
- Pharmacology
- Infectious Diseases
- Pediatric Oncology
Background:
- Standard vancomycin dosing often fails to achieve therapeutic serum levels in severe infections.
- Optimizing vancomycin therapy is critical for treating resistant bacterial infections.
Purpose of the Study:
- To evaluate the effectiveness of vancomycin treatment by analyzing the area under the concentration curve/minimum inhibitory concentration (AUC/MIC) ratio.
- To determine optimal vancomycin dosing strategies in pediatric patients with oncologic/hematologic diseases.
Main Methods:
- Retrospective analysis of vancomycin trough serum concentrations in 31 patients.
- Bayesian analysis to calculate vancomycin clearance, distribution volume, and peak concentrations.
- Calculation of the AUC/MIC ratio to assess treatment efficacy, targeting a ratio > 400.
Main Results:
- 55.7% of dosages achieved the target AUC/MIC ratio > 400, with a mean required dose of 81 mg/kg/day.
- Standard vancomycin doses (40-60 mg/kg/day) achieved AUC/MIC > 400 in 50% of cases.
- Trough concentrations > 15 mg/L had a 100% positive predictive value for AUC/MIC > 400.
Conclusions:
- Higher vancomycin doses may be necessary for treating staphylococcal infections in immunocompromised children.
- The AUC/MIC ratio is the primary predictor of vancomycin efficacy.
- Therapeutic drug monitoring, including trough concentrations, MICs, and pharmacokinetic analysis, is essential for optimizing vancomycin treatment.
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