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Population Pharmacokinetics of Vancomycin in Pediatric Extracorporeal Membrane Oxygenation

Brady S Moffett1,2, Jennifer Morris1,2, Marianne Galati3

  • 1Department of Pharmacy, Texas Children's Hospital, Houston, TX.

Pediatric Critical Care Medicine : a Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies
|August 1, 2018
PubMed

Insights

Vancomycin dosing for pediatric patients on extracorporeal membrane oxygenation (ECMO) requires careful consideration. Doses of 25-30 mg/kg every 12-24 hours are recommended to achieve therapeutic vancomycin levels.

Area of Science:

  • Pharmacokinetics and Pharmacodynamics
  • Pediatric Critical Care Medicine
  • Extracorporeal Membrane Oxygenation

Background:

  • Vancomycin is crucial for treating Gram-positive infections in critically ill children.
  • Extracorporeal membrane oxygenation (ECMO) alters drug pharmacokinetics, necessitating optimized dosing.
  • Limited data exist on vancomycin pharmacokinetics in pediatric ECMO patients.

Purpose of the Study:

  • To characterize vancomycin pharmacokinetics in pediatric patients undergoing ECMO.
  • To establish dosing recommendations for vancomycin in this population.
  • To achieve a target area under the curve (AUC) of >400 mg*h/L for 24 hours.

Main Methods:

  • Retrospective population pharmacokinetic analysis using NONMEM v7.3.
  • Included pediatric patients (<19 years) receiving IV vancomycin during ECMO.
  • Developed a two-compartment model with covariates including weight, serum creatinine, postmenstrual age, patient age, and albumin.

Main Results:

  • 93 pediatric patients were analyzed (median age 0.64 years).
  • Significant covariates for clearance included serum creatinine and postmenstrual age.
  • Significant covariates for volume of distribution included patient age and albumin.
  • Simulations suggested 25-30 mg/kg/dose every 12-24 hours optimizes AUC > 400 and trough concentrations < 15 mg/L.

Conclusions:

  • A vancomycin dosage of 25-30 mg/kg every 12-24 hours is recommended for pediatric ECMO patients.
  • Therapeutic drug monitoring is essential to ensure optimal vancomycin exposure.
  • This dosing strategy aims to achieve target vancomycin AUC > 400 mg*h/L.
Abstract

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