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Nomogram based on actual body weight for estimation of vancomycin maintenance dose in infants

Pavla Pokorná1,2,3, Martin Šíma1, Olga Černá2

  • 1a Institute of Pharmacology, First Faculty of Medicine , Charles University and General University Hospital in Prague , Prague , Czech Republic.

Infectious Diseases (London, England)
|April 6, 2019
PubMed

Insights

Optimizing vancomycin dosing in infants is crucial. Actual body weight is the best predictor for vancomycin clearance, enabling a new dosing nomogram for effective sepsis treatment.

Area of Science:

  • Pediatric Pharmacology
  • Infectious Diseases
  • Antibiotic Stewardship

Background:

  • Vancomycin is the primary antibiotic for infants with resistant gram-positive bacterial infections.
  • Optimal vancomycin dosing in infants remains a clinical challenge despite extensive use.
  • This study addresses the need for improved vancomycin dosing strategies in pediatric sepsis.

Purpose of the Study:

  • To identify predictors of vancomycin clearance in infants.
  • To develop an evidence-based method for optimal maintenance dosing of vancomycin.
  • To create a practical tool for guiding vancomycin therapy in pediatric sepsis.

Main Methods:

  • Pharmacokinetic analysis using a one-compartmental model based on serum concentrations.
  • Linear regression to identify covariates associated with vancomycin clearance.
  • Development of a dosing nomogram based on predictive variables.

Main Results:

  • Twenty-two infants were included in the study.
  • Vancomycin clearance was significantly associated with actual body weight, height, body surface area, gestational age, postnatal age, postmenstrual age, and estimated glomerular filtration rate.
  • Actual body weight emerged as the strongest predictor of vancomycin clearance.

Conclusions:

  • An easy-to-use dosing nomogram was developed, utilizing actual body weight.
  • The nomogram facilitates maintaining a target vancomycin average steady-state concentration of 22.5 mg/L.
  • This tool aims to optimize vancomycin therapy in infants with suspected or confirmed sepsis.
Abstract

Keywords:
Vancomycinactual body weightinfantspharmacokineticstherapeutic drug monitoring

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