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Vancomycin use, dosing and serum trough concentrations in the pediatric population: a retrospective institutional
Kevin Rajon1, Regis Vaillancourt2, Nisha Varughese3
1Pharmaceutical and Biological Sciences Institute, Faculty of Medicine and Pharmacy. University of Lyon. Lyon (France). kr.rajon@gmail.com.
Insights
Vancomycin dosing of 60 mg/kg/day achieved therapeutic levels in most infants and adolescents. However, some children aged 1-12 years did not reach target vancomycin trough levels, indicating a need for further investigation.
Area of Science:
- Pharmacology
- Pediatric Infectious Diseases
- Clinical Pharmacy
Background:
- Vancomycin is a critical antibiotic for Gram-positive bacterial infections.
- Therapeutic drug monitoring for vancomycin is essential due to institutional variations in dosing and target levels.
Purpose of the Study:
- To analyze initial vancomycin (Vanc) doses and patient age in relation to achieved therapeutic trough levels.
- To assess the appropriateness of vancomycin utilization within a hospital setting.
Main Methods:
- Retrospective chart review of 164 pediatric patients receiving intravenous vancomycin.
- Patients categorized by age (neonates, infants, children, adolescents) and duration of vancomycin therapy (≤5 days vs. >5 days).
- Evaluation of initial vancomycin dosing regimens and corresponding trough levels (drawn around 3rd-5th dose), with acceptable range of 5-20 mg/L.
Main Results:
- 83% of 229 vancomycin courses were for ≤5 days.
- Empiric vancomycin dosing of 60 mg/kg/day achieved initial trough levels >5 mg/L in 88.9% of infants and 100% of adolescents.
- In the pediatric group (aged 1-12 years), 37.7% of patients failed to reach trough levels >5 mg/L.
- All tested methicillin-resistant Staphylococcus aureus isolates (n=4) had vancomycin minimum inhibitory concentration (MIC) values ≤1 mg/L.
Conclusions:
- Initial empiric vancomycin dosing of 60 mg/kg/day is effective in achieving target levels (≥5 mg/L) in most infants and adolescents.
- The reasons for sub-therapeutic vancomycin trough levels in some children aged 1-12 years require further investigation.
- Vancomycin use appears appropriate for Gram-positive infections, with low MICs observed in MRSA cases.
Background:
Vancomycin is used primarily for Gram-positive infections. Recommended dosage regimens and targeted therapeutic levels vary between institutions.
Objectives:
This study aims to describe therapeutic levels according to initial vancomycin doses and patient's age. A secondary objective was to evaluate appropriateness of vancomycin use in our hospital.
Methods:
A retrospective chart review was conducted at the Children's Hospital of Eastern Ontario. Patients included in this study were classified by age (neonates, infants, children and adolescents) and categorized into those who received vancomycin ≤5 and >5 days. Initial vancomycin dosing regimens and corresponding initial trough levels obtained were evaluated. Initial trough levels drawn in relation to the third, fourth, or fifth doses corresponding to the first course of therapy were analyzed. Acceptable trough levels ranged from 5-20 mg/L.
Results:
One-hundred-and-sixty-four patients who received intravenous vancomycin in 2013 were included. Of the 229 courses of vancomycin, 190 (83%) were used 5 days or less (mean 4.9 days). Sixteen infants (88.9%) and 21 adolescents (100%), who received vancomycin empiric dosing of 60 mg/kg/day, had initial trough levels >5mg/L. However, in the children's group 20 (37.7%) did not reach levels >5 mg/L. None of vancomycin minimum inhibitory concentration (MIC) values were >1mg/L for the four patients who had infections due to methicillin-resistant Staphylococcus aureus strains.
Conclusions:
In our institution, initial empiric vancomycin dosing of 60 mg/kg/day resulted in levels ≥5mg/L in most infants and adolescents. It remains unclear why some children aged 1-12 years did not achieve these levels.
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