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Clinical evaluation of vancomycin dosage in pediatric oncology patients

Stefan J W J Sanders1, Yuma A Bijleveld, Fleur Sinkeler

  • 1From the *Department of Clinical Pharmacy; †Department of Pediatric Infectious Diseases; and ‡Department of Pediatric Oncology, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands.

The Pediatric Infectious Disease Journal
|January 22, 2014
PubMed

Insights

A vancomycin dosage of 60 mg/kg/d was insufficient for over half of pediatric oncology patients, particularly those over 12 years old. This highlights the need for optimized vancomycin dosing in this vulnerable population.

Area of Science:

  • Pediatric Oncology
  • Pharmacokinetics
  • Infectious Diseases

Background:

  • Vancomycin is crucial for treating serious Gram-positive infections in pediatric oncology patients.
  • Subtherapeutic vancomycin trough concentrations are associated with treatment failure and resistance.
  • Optimizing vancomycin dosing is essential to ensure efficacy and safety in immunocompromised children.

Purpose of the Study:

  • To evaluate the adequacy of a 60 mg/kg/d vancomycin dosage in pediatric oncology patients.
  • To identify age-related differences in vancomycin trough concentrations.
  • To inform optimal vancomycin dosing strategies for pediatric cancer patients.

Main Methods:

  • Retrospective analysis of 124 pediatric oncology patients.
  • Measurement of vancomycin trough serum concentrations.
  • Dosage adjusted based on weight (60 mg/kg/d) divided every 6 hours.
  • Comparison of trough concentrations across different age groups.

Main Results:

  • 58% of patients had vancomycin trough concentrations below the therapeutic range (8-15 mg/L).
  • Younger patients (<6 and 6-12 years) exhibited significantly lower trough concentrations compared to older patients (>12 years).
  • The 60 mg/kg/d dosage was inadequate for achieving therapeutic levels in patients over 12 years old.

Conclusions:

  • A vancomycin dosage of 60 mg/kg/d is frequently subtherapeutic in pediatric oncology patients.
  • Age is a significant factor influencing vancomycin pharmacokinetics in this population.
  • Current dosing guidelines may require adjustment for pediatric oncology patients, especially older children, to ensure effective vancomycin therapy.

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