Relationship between vancomycin dosage and serum trough vancomycin concentrations in pediatric patients with cystic
Spencer H Durham1, Kimberly B Garza2, Lea S Eiland3
1Department of Pharmacy Practice, Auburn University Harrison School of Pharmacy, Auburn, AL. durhash@auburn.edu.
Insights
Vancomycin dosage did not correlate with serum trough concentrations in pediatric cystic fibrosis patients overall. However, a significant correlation was observed in patients aged 12 and older.
Area of Science:
- Pharmacology
- Pediatrics
- Infectious Diseases
Background:
- Cystic Fibrosis (CF) patients often require vancomycin for infections.
- Optimizing vancomycin dosing is crucial for efficacy and safety in pediatric CF.
- Understanding the relationship between dosage and serum concentrations is key for therapeutic drug monitoring.
Purpose of the Study:
- To examine the association between vancomycin dosage and serum trough concentrations in pediatric patients with cystic fibrosis (CF).
- To determine if age influences the correlation between vancomycin dosage and serum trough levels in this population.
Main Methods:
- Retrospective chart review of pediatric CF patients receiving vancomycin (2006-2012).
- Collected data on vancomycin dosage regimens and serum trough concentrations.
- Utilized statistical analyses including t-tests, ANOVA, and Pearson's correlation coefficients.
Main Results:
- Analyzed data from 40 hospital admissions (31 patients).
- No significant correlation found between initial or final vancomycin dosage and trough concentrations when all patients were considered.
- Significant positive correlations were observed in patients aged 12 years or older, but not in younger patients.
Conclusions:
- Overall, vancomycin dosage regimens did not significantly correlate with serum trough concentrations in pediatric CF patients.
- Age appears to be a significant factor, with older pediatric patients (≥12 years) showing a correlation between vancomycin dose and concentration.
- Further investigation into age-specific dosing strategies for vancomycin in pediatric CF may be warranted.
Purpose:
The association between vancomycin dosage and serum trough vancomycin concentrations in pediatric patients with cystic fibrosis (CF) was examined.
Methods:
A retrospective chart review was conducted for pediatric patients with CF who received vancomycin between 2006 and 2012 at a children's hospital. Admission-level data, including vancomycin dosage regimens and corresponding serum trough vancomycin concentrations, were collected. Student's t tests, analysis of variance, and Pearson's correlation coefficients were used to test for associations between vancomycin dosage and trough concentrations.
Results:
Data from 40 hospital admissions (31 patients) were analyzed. Initial vancomycin dosages ranged from 45 to 100 mg/kg/day (mean ± S.D. 62.9 ± 14.5 mg/kg/day), and the mean ± S.D. serum trough vancomycin concentration was 9.7 ± 5.1 mg/L. Patients received a mean ± S.D. of 1.5 ± 1.1 dosage adjustments. Final dosage regimens ranged from 50 to 120 mg/kg/day (mean ± S.D., 78.8 ± 16.0 mg/kg/day), and the mean ± S.D. trough vancomycin concentration was 13.6 ± 4.4 mg/L. There was no significant correlation between the initial (r = -0.272, p = 0.090) or final (r = 0.024, p = 0.882) vancomycin dosage and corresponding trough vancomycin concentration. A significant correlation was found between dosage and trough vancomycin concentration in patients age 12 years or older for the initial (r = 0.545, p = 0.003) and final (r = 0.425, p = 0.024) dosages, with no significant correlations found in patients younger than 12 years.
Conclusion:
A study of hospital admissions involving pediatric patients with CF revealed no significant correlation, when all admissions were considered, between the initial or final vancomycin dosage regimen and the corresponding serum trough vancomycin concentration. Both correlations were significant for the subgroup of admissions representing patients who were at least 12 years old.
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