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Assessment of initial serum vancomycin trough concentrations and their association with initial empirical

Kelly L Matson1, Christopher L Shaffer, Gary L Beck

  • 1Department of Pharmacy Practice, University of Rhode Island, Kingston, Rhode Island.

Pharmacotherapy
|March 11, 2015
PubMed

Insights

Vancomycin dosing and trough levels in children did not correlate with nephrotoxicity. Instead, combining vancomycin with other nephrotoxic drugs significantly increased the risk of kidney damage in pediatric patients.

Area of Science:

  • Pediatric Nephrology
  • Pharmacology
  • Infectious Diseases

Background:

  • Vancomycin is a critical antibiotic for treating Gram-positive bacterial infections in children.
  • Understanding factors influencing vancomycin efficacy and safety, particularly nephrotoxicity, is crucial for optimizing pediatric care.
  • Previous studies have explored associations between vancomycin dosing, serum concentrations, and adverse events, but data in pediatric populations require further clarification.

Purpose of the Study:

  • To investigate the relationship between initial vancomycin trough concentrations and empirical dose, patient weight, and age in pediatric patients.
  • To identify risk factors for vancomycin-associated nephrotoxicity in children across different hospital settings.
  • To evaluate the impact of concomitant medications on vancomycin-induced nephrotoxicity.

Main Methods:

  • Retrospective analysis of data from 316 pediatric patients treated with vancomycin at two tertiary care centers.
  • Statistical methods included stepwise linear and multinomial logistic regression.
  • Patients excluded had pre-existing renal dysfunction or were in the neonatal intensive care unit.

Main Results:

  • No significant relationship was found between initial vancomycin trough concentrations and empirical dosing, weight, or age.
  • Vancomycin trough concentrations below 20 mg/L were not associated with an increased risk of nephrotoxicity.
  • Concomitant use of nephrotoxic agents (loop diuretics, vasopressors, ACE inhibitors, NSAIDs) significantly increased the risk of nephrotoxicity in medical-surgical and intensive care unit patients.

Conclusions:

  • Initial empirical weight-based vancomycin dosing and elevated serum trough concentrations are not significantly associated with nephrotoxicity in children.
  • Nephrotoxicity in pediatric patients receiving vancomycin is primarily linked to the concurrent administration of other potentially nephrotoxic medications.
  • This study highlights the importance of careful monitoring and avoidance of combination therapy with multiple nephrotoxic agents in pediatric patients treated with vancomycin.
Abstract

Keywords:
drug monitoringnephrotoxicitypediatricsvancomycin

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