Related Experiment Video
Updated: Mar 23, 2026
Anesthesia and Intubation of Preadolescent Mouse Pups for Cardiothoracic Surgery
Published on: June 2, 2022
Vancomycin Dosing and Pharmacokinetics in Postoperative Pediatric Cardiothoracic Surgery Patients
Emily C Benefield1, Tracy M Hagemann2, H Christine Allen3
1Primary Children's Hospital, Salt Lake City, Utah.
Insights
Pediatric cardiothoracic surgery patients had higher vancomycin levels and more acute kidney injury (AKI) than controls. Individualized dosing is needed for vancomycin in these patients to achieve therapeutic targets and reduce AKI risk.
Area of Science:
- Pharmacology
- Pediatric Critical Care
- Cardiothoracic Surgery
Background:
- Vancomycin is crucial for treating Gram-positive infections, especially in vulnerable pediatric populations.
- Optimizing vancomycin dosing is essential to balance efficacy and minimize toxicity, particularly in patients undergoing cardiothoracic surgery (CTS).
- Acute kidney injury (AKI) is a significant concern associated with vancomycin therapy.
Purpose of the Study:
- To compare vancomycin trough concentrations and pharmacokinetic parameters in pediatric CTS patients versus a matched control group.
- To assess the incidence of vancomycin-associated AKI in these pediatric populations.
- To develop vancomycin dosing projections for CTS patients to achieve a target area-under-the-curve-to-minimum inhibitory concentration (AUC:MIC) ratio of ≥400.
Main Methods:
- Retrospective study comparing pediatric patients (<18 years) post-CTS with an age- and sex-matched control group.
- Analysis of vancomycin trough concentrations, pharmacokinetic parameters, and incidence of AKI (defined as doubling of serum creatinine).
- Development of dosing projections to achieve a target AUC:MIC ratio of ≥400.
Main Results:
- Mean vancomycin trough concentrations were significantly higher in the CTS group (18.4 mg/L) compared to controls (8.8 mg/L) (p < 0.01).
- Vancomycin-associated AKI occurred significantly more often in the CTS group (25.9%) than in controls (0%) (p < 0.01).
- Vancomycin elimination rates were significantly different and highly variable in CTS patients; other pharmacokinetic parameters showed no statistical differences.
Conclusions:
- Standard vancomycin dosing (20 mg/kg every 8 hours) results in higher trough concentrations and increased AKI risk in pediatric CTS patients.
- High variability in vancomycin pharmacokinetics necessitates individualized dosing strategies for CTS patients.
- Further prospective studies are required to validate revised dosing projections and assess their impact on achieving therapeutic targets and reducing AKI.
Objectives:
This study compared vancomycin trough concentrations and pharmacokinetic parameters in pediatric cardiothoracic surgery (CTS) patients versus those in controls receiving 20 mg/kg/dose, intravenously, every 8 hours.
Methods:
A retrospective study was conducted in children <18 years of age, following CTS, versus an age-and sex-matched control group. The primary objective was to determine differences in trough concentrations between groups. Secondary objectives included comparisons of pharmacokinetics between groups and development of vancomycin-associated acute kidney injury (AKI), defined as a doubling in serum creatinine from baseline. Also dosing projections were developed to target an area-under-the-curve-to-minimum inhibitory concentration (AUC:MIC) ratio of ≥400.
Results:
Twenty-seven patients in each group were evaluated. Mean trough concentrations were significantly different between groups (CTS: 18.4 mg/L; control: 8.8 mg/L; p < 0.01). Vancomycin-associated acute kidney injury AKI was significantly higher in the CTS group than in controls (25.9% versus 0%, respectively, p<0.01). There were significant differences in vancomycin elimination rates, with a high degree of variability, but no statistical differences in other parameters. Based on dosing projections, CTS patients would require 21 to 88 mg/kg/day, with a dosage interval determined by the child's glomerular filtration rate to achieve the target AUC:MIC ≥400.
Conclusions:
Vancomycin dosage of 20 mg/kg/dose intravenously every 8 hours achieved significantly higher trough concentrations in CTS patients than in controls. Pharmacokinetic parameters were highly variable in CTS patients, indicating more individualization of dosage is needed. A future prospective study is needed to determine whether the revised dosage projections achieve the AUC:MIC target and to determine whether these regimens are associated with less vancomycin-associated AKI.
Related Concept Videos
01:26Pharmacokinetics in Pediatric Patients: Drug Excretion
01:17Pharmacokinetics in Pediatric Patients: Drug Distribution
01:24Pharmacokinetics in Pediatric Patients: Drug Metabolism
01:28Cardiomyopathy VII: Pre and Post Operative Nursing Management
01:29Drug Dosing: Infants and Children
01:23Pharmacokinetics in Pediatric Patients: Overview and Drug Absorption