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Individualised vancomycin doses for paediatric burn patients to achieve PK/PD targets

David S Gomez1, Edvaldo V Campos, Rodrigo P de Azevedo

  • 1Plastic Surgery and Burns Division, Hospital das Clinicas/Medical School, University of Sao Paulo, Sao Paulo/SP, Brazil. davgomez@usp.br

Burns : Journal of the International Society for Burn Injuries
|August 8, 2012
PubMed

Insights

Vancomycin dosing in pediatric burn patients requires adjustment for optimal therapeutic drug monitoring. Higher initial doses (90-100mg/kg/day) may be needed to achieve pharmacokinetic/pharmacodynamic targets.

Area of Science:

  • Pharmacology
  • Pediatric Medicine
  • Critical Care

Background:

  • Vancomycin is crucial for treating infections in pediatric burn patients.
  • Optimizing vancomycin dosage is essential for effective treatment and minimizing resistance.
  • Pharmacokinetic and pharmacodynamic (PK/PD) parameters guide vancomycin dose adjustments.

Purpose of the Study:

  • To investigate vancomycin dose adjustments in pediatric burn patients.
  • To evaluate trough drug concentrations and PK/PD correlations.
  • To determine optimal dosing strategies for this specific population.

Main Methods:

  • Prospective study of 13 pediatric burn patients (median age 6.0 years, 25 kg) with normal renal function and ≥30% total burn surface area.
  • Serial blood sample collection for vancomycin plasma concentration monitoring and PK assessments.
  • High-performance liquid chromatography used for plasma measurements; PK/PD target set at AUC0-24(ss)/MIC > 400.

Main Results:

  • 53% of initial vancomycin trough values were <10 μg/mL due to increased clearance and volume of distribution.
  • The daily vancomycin dose was increased from 43.4 ± 9.0 mg/kg to 98.0 ± 17.9 mg/kg (p<0.05).
  • The PK/PD target was achieved in 93.3% of cases for pathogens with MIC ≤ 0.5 mg/L, decreasing with higher MICs.

Conclusions:

  • An initial vancomycin dose of approximately 90-100 mg/kg/day is recommended for pediatric burn patients with normal renal function to rapidly achieve PK/PD targets.
  • Further evaluation of this higher dosage regimen is necessary to assess efficacy, toxicity, and pharmacodynamic goal achievement.
  • Optimized vancomycin dosing is critical for effective treatment in this vulnerable pediatric population.
Abstract

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