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Vancomycin dosing in healthy-weight, overweight, and obese pediatric patients

Lea S Eiland1, Kalyani B Sonawane2

  • 1Department of Pharmacy Practice, Auburn University Harrison School of Pharmacy, Huntsville, Alabama.

The Journal of Pediatric Pharmacology and Therapeutics : JPPT : the Official Journal of PPAG
|October 14, 2014
PubMed

Insights

Vancomycin dosing in children frequently missed target serum concentrations, regardless of weight. Current empiric dosing strategies require reevaluation for both healthy-weight and overweight/obese pediatric patients to improve efficacy.

Area of Science:

  • Pediatric pharmacology
  • Infectious disease pharmacotherapy

Background:

  • Rising vancomycin resistance and childhood obesity necessitate optimized dosing.
  • Current vancomycin dosing may not achieve therapeutic serum concentrations in pediatric patients.

Purpose of the Study:

  • To describe initial vancomycin dosing and serum concentrations in healthy-weight versus overweight/obese children.
  • To compare dosing regimens achieving target concentrations and identify factors influencing attainment.

Main Methods:

  • Retrospective review of 98 pediatric patients (aged 2-18 years) with vancomycin trough serum concentrations (2005-2010).
  • Analysis of vancomycin dosing, serum concentrations, pharmacokinetics, and patient demographics.
  • Target trough concentration defined as 10-20 mg/L.

Main Results:

  • Only 14.2% of patients achieved target trough concentrations with empiric dosing.
  • No significant difference in mean daily vancomycin dosing (mg/kg/day) was found between healthy-weight and overweight/obese patients.
  • Patient characteristics did not predict the likelihood of achieving target concentrations.

Conclusions:

  • Empiric vancomycin dosing frequently fails to achieve target serum concentrations in pediatric patients, including those who are overweight or obese.
  • Current dosing strategies do not differ between weight categories for achieving initial target concentrations.
  • Further research into alternative dosing strategies and therapeutic monitoring is crucial for this population.
Abstract

Keywords:
childrendosingobesepharmacokineticsvancomycin

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