Experience with Continuous Infusion Vancomycin Dosing in a Large Pediatric Hospital

Area of Science:

• Pediatric Pharmacology
• Infectious Diseases
• Pharmacokinetics

Background:

• Limited data exists on continuous infusion vancomycin (CIV) dosing in pediatric patients.
• CIV offers an alternative to intermittent vancomycin infusions, potentially avoiding dose escalation.
• Establishing optimal CIV dosing is crucial for therapeutic efficacy in children.

Purpose of the Study:

• To determine the total daily dose of CIV needed for therapeutic serum vancomycin concentrations (SVCs) in pediatric patients.
• To analyze CIV dosing requirements across different pediatric age groups (≥31 days to <2 years, 2 to <8 years, and 8 to <18 years).

Main Methods:

• Retrospective evaluation of pediatric patients transitioned from intermittent to continuous infusion vancomycin.
• Data collected included patient demographics, vancomycin dosing, steady-state SVCs, and adverse events.
• Analysis focused on identifying CIV doses required to achieve target SVCs (10-15 µg/mL and 15-20 µg/mL).

Main Results:

• Younger pediatric patients (<2 years and 2 to <8 years) required higher daily CIV doses (48.4 mg/kg/day and 50.2-50.6 mg/kg/day, respectively) to reach target SVCs compared to older children (≥8 years).
• Specifically, for SVCs of 10-15 µg/mL, doses were 48.4 mg/kg/day (youngest) vs. 45.6 and 39.4 mg/kg/day (older).
• For SVCs of 15-20 µg/mL, doses were 50.2-50.6 mg/kg/day (younger) vs. 44.7 mg/kg/day (older).

Conclusions:

• Continuous infusion vancomycin (CIV) is an effective strategy for achieving therapeutic serum vancomycin concentrations in pediatric patients.
• Pediatric patients under 8 years of age necessitate higher CIV doses to attain target SVCs compared to older pediatric patients.
• These findings support age-specific dosing adjustments for CIV in pediatric populations.