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Balancing vancomycin efficacy and nephrotoxicity: should we be aiming for trough or AUC/MIC?

Karisma Patel1, Ashley S Crumby, Holly D Maples

  • 1Infectious Diseases, Children's Mercy Hospital, 2401 Gillham Rd, Kansas City, MO, 64108, USA.

Paediatric Drugs
|February 4, 2015
PubMed

Insights

Pediatric vancomycin dosing needs reevaluation. Current guidelines, based on adult data, may not achieve optimal therapeutic targets (area under the curve to minimum inhibitory concentration ratio) in children for invasive infections.

Area of Science:

  • Pediatric pharmacology and infectious diseases.
  • Antimicrobial stewardship and drug monitoring.

Background:

  • The 2011 Infectious Diseases Society of America guidelines offer vancomycin dosing and monitoring recommendations for pediatric patients.
  • These guidelines recommend goal vancomycin trough concentrations of 15-20 μg/mL for invasive methicillin-resistant Staphylococcus aureus infections, primarily derived from adult pharmacokinetic/pharmacodynamic data.
  • Adult data aimed for an area under the curve to minimum inhibitory concentration (AUC/MIC) ratio of ≥400.

Purpose of the Study:

  • To address the ongoing question of appropriate vancomycin utilization in the pediatric population.
  • To highlight discrepancies between adult-derived vancomycin targets and recent pediatric literature findings.
  • To explore the role of vancomycin AUC/MIC in pediatric dosing, safety, and laboratory reporting.

Main Methods:

  • Review of recent pediatric literature concerning vancomycin pharmacokinetics and pharmacodynamics.
  • Analysis of discrepancies in achieving target AUC/MIC ratios in pediatric versus adult populations.
  • Discussion of implications for current dosing strategies, safety monitoring, and laboratory practices.

Main Results:

  • Recent pediatric studies suggest that the vancomycin trough concentrations required to achieve the target AUC/MIC ratio of ≥400 differ from the adult-derived goals.
  • This indicates a potential need for adjusted dosing strategies in pediatric patients to ensure therapeutic efficacy.
  • Variability in laboratory reporting of minimum inhibitory concentrations (MICs) may further complicate accurate AUC/MIC calculation.

Conclusions:

  • Current vancomycin dosing guidelines for pediatric invasive infections may not be optimal.
  • Pediatric-specific pharmacokinetic and pharmacodynamic data are crucial for refining vancomycin dosing strategies.
  • Future research should focus on establishing reliable methods for calculating AUC/MIC in children and standardizing laboratory reporting.

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