Related Experiment Video
Updated: Apr 13, 2026
A Reference Broth Microdilution Method for Dalbavancin In Vitro Susceptibility Testing of Bacteria that Grow Aerobically
Published on: September 9, 2015
An evaluation of vancomycin dosing for complicated infections in pediatric patients
Spencer H Durham1, Marroyln L Simmons2, Diana W Mulherin3
1Auburn University Harrison School of Pharmacy, Auburn, Alabama; durhash@auburn.edu.
Insights
The standard vancomycin dose of 15 mg/kg every 6 hours is unlikely to achieve therapeutic levels in children with serious infections. A higher daily dose of 80 mg/kg may be more effective for pediatric vancomycin therapy.
Area of Science:
- Pediatric Infectious Diseases
- Pharmacokinetics and Drug Dosing
- Antibiotic Stewardship
Background:
- Vancomycin is a critical antibiotic for treating serious Gram-positive bacterial infections in children.
- Achieving therapeutic vancomycin trough concentrations (15-20 mg/L) is essential for efficacy and minimizing resistance.
- Current dosing guidelines may not consistently achieve target troughs in pediatric populations with complicated infections.
Purpose of the Study:
- To evaluate the incidence of achieving target vancomycin trough concentrations (15-20 mg/L) with a 15 mg/kg every 6 hours regimen.
- To identify factors influencing vancomycin trough attainment in pediatric patients.
- To inform optimal vancomycin dosing strategies for complicated pediatric infections.
Main Methods:
- Retrospective chart review of pediatric patients (1 month-18 years) admitted between 2009-2011.
- Inclusion criteria: complicated infections (meningitis, pneumonia, osteomyelitis, bacteremia/sepsis, endocarditis) and at least one steady-state vancomycin trough.
- Analysis of initial vancomycin dose (15 mg/kg every 6 hours) and subsequent trough levels.
Main Results:
- Only 6.8% of 74 pediatric patients achieved initial target vancomycin troughs (15-20 mg/L).
- Younger children (1.0-5.9 years) were significantly less likely to reach therapeutic troughs (P=.041).
- After dose adjustment, 44.1% of patients reached therapeutic troughs, with a median effective daily dose of 80 mg/kg.
Conclusions:
- The standard 15 mg/kg every 6 hours vancomycin regimen is inadequate for achieving therapeutic troughs in pediatric patients with complicated infections.
- A higher initial daily vancomycin dose of 80 mg/kg may be necessary to ensure therapeutic concentrations.
- Individualized vancomycin dosing adjustments are crucial for optimizing treatment outcomes in pediatric patients.
Objective:
To determine the incidence with which a vancomycin dosing regimen of 15 mg/kg per dose every 6 hours achieves steady-state trough concentrations of 15 to 20 mg/L in pediatric patients with complicated infections.
Methods:
We performed a retrospective chart review for patients admitted to our children's hospital between July 1, 2009, and June 30, 2011. Patients were included if they were between 1 month and 18 years of age, had at least 1 steady-state vancomycin trough obtained, received an initial vancomycin dose of 15 mg/kg per dose every 6 hours, and were being treated for a diagnosis of meningitis, pneumonia, osteomyelitis, bacteremia/sepsis, or endocarditis.
Results:
Seventy-four patients were enrolled, mean age of 4.2±3.9 years and weight of 17.0±11.2 kg. Five (6.8%) patients obtained an initial trough of 15 to 20 mg/L. Patients between 1.0 and 5.9 years of age were significantly less likely to achieve an initial trough of 15 to 20 mg/L compared with other age groups evaluated (P=.041). Thirty-four patients with initial subtherapeutic troughs received a dose adjustment and a follow-up vancomycin trough. Of these patients, 15 (44.1%) achieved a trough between 15 and 20 mg/L. The median dose for patients achieving a therapeutic trough at any point during the study was 80 mg/kg per day.
Conclusions:
A vancomycin dosing regimen of 15 mg/kg per dose every 6 hours is not likely to achieve a trough concentration of 15 to 20 mg/L in pediatric patients with complicated infections. An initial regimen of 80 mg/kg per day for these patients may be more likely to result in therapeutic steady-state concentrations of vancomycin.
Related Concept Videos
01:26Pharmacokinetics in Pediatric Patients: Drug Excretion
01:29Drug Dosing: Infants and Children
01:20Estimation of k and VD of Aminoglycosides
01:15Determination of Multiple Dosing Parameters: Steady-State, Minimum and Maximum Concentrations
01:24Pharmacokinetics in Pediatric Patients: Drug Metabolism
01:19Dosage Interval and Administration Route: Determination Methods