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Evaluation of vancomycin dosing and corresponding drug concentrations in pediatric patients

Lauren Maurer Geerlof1, Jenny Boucher2

  • 1Lehigh Valley Health Network, Allentown, Pennsylvania lauren.geerlof@lvhn.org.

Hospital Pediatrics
|November 2, 2014
PubMed

Insights

Vancomycin dosing in pediatric patients often fails to reach target trough concentrations. Younger children require higher doses (>60 mg/kg/day) to achieve therapeutic vancomycin levels, highlighting a need for optimized dosing strategies.

Area of Science:

  • Pharmacology
  • Pediatric Medicine
  • Infectious Diseases

Background:

  • Vancomycin is a critical antibiotic for treating serious Gram-positive infections in pediatric patients.
  • Achieving therapeutic vancomycin trough concentrations is essential for efficacy and minimizing resistance.
  • Pediatric dosing strategies require careful consideration due to pharmacokinetic variations across age groups.

Purpose of the Study:

  • To investigate the relationship between vancomycin dosing strategies, patient age, and achieved trough concentrations in pediatric inpatients.
  • To evaluate the proportion of pediatric patients reaching target vancomycin trough levels (10-20 μg/mL).
  • To assess the incidence of vancomycin-induced nephrotoxicity in relation to dosing and trough levels.

Main Methods:

  • Retrospective review of 102 hospitalized pediatric patients (2 months to 17 years) treated with intravenous vancomycin (2008-2011).
  • Analysis of vancomycin trough concentrations against target ranges of 10-20 μg/mL and 15-20 μg/mL.
  • Statistical evaluation of the impact of dose and age on achieving target trough concentrations and the incidence of nephrotoxicity.

Main Results:

  • Only 28.9% of evaluated vancomycin troughs (159 total) were within the target range of 10-20 μg/mL.
  • Vancomycin dose significantly influenced the ability to achieve therapeutic trough concentrations (P = .01).
  • A low percentage (6.9%) achieved the higher target range of 15-20 μg/mL; nephrotoxicity occurred in 7 patients without clear association to dose or trough levels.

Conclusions:

  • A low proportion of pediatric patients achieved target vancomycin trough concentrations (10-20 μg/mL).
  • Younger pediatric patients frequently required higher vancomycin doses (>60 mg/kg/day) to reach therapeutic trough levels.
  • Vancomycin dosing strategy is a significant factor in achieving target trough concentrations in pediatric populations.
Abstract

Keywords:
MRSAStaphylococcus aureusantibioticchildchildreninfantmethicillin-resistantpediatricpharmacodynamicspharmacokineticserum concentrationtroughvancomycin

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