Related Experiment Video

Updated: Dec 25, 2025

Assessment of Child Anthropometry in a Large Epidemiologic Study
09:36

Assessment of Child Anthropometry in a Large Epidemiologic Study

Published on: February 2, 2017

27.6K

Vancomycin Dosing in Children With Overweight or Obesity: A Systematic Review and Meta-analysis

Manaswitha Khare1, Aniqa Azim2, Garrett Kneese2

  • 1Department of Pediatrics, University of California, San Diego, San Diego, California.

Hospital Pediatrics
|March 28, 2020
PubMed

Insights

Vancomycin dosing using total body weight in children with overweight or obesity may lead to higher concentrations. Further research is needed to optimize vancomycin dosing for these pediatric populations.

Area of Science:

  • Pharmacology
  • Pediatric Medicine
  • Clinical Pharmacy

Background:

  • Vancomycin is critical for treating infections but has a narrow therapeutic index, risking toxicity or treatment failure.
  • Obesity is prevalent in children and may alter vancomycin pharmacokinetics, complicating appropriate dosing.
  • Current dosing strategies may not be optimal for pediatric patients with overweight or obesity.

Purpose of the Study:

  • To investigate whether children with overweight or obesity exhibit higher vancomycin trough concentrations compared to normal-weight children when dosed by total body weight (TBW).

Main Methods:

  • A systematic literature search was conducted in Medline and Medline In-Process & Other Non-Indexed Citations from 1952 to November 2017.
  • Studies involving vancomycin, body weight, and body composition in children were reviewed and screened.
  • A meta-analysis of 4 studies (N=521) was performed to compare vancomycin trough levels.

Main Results:

  • Seven studies were identified, with most employing a matched case-control design, though methodology varied.
  • Meta-analysis revealed a statistically significant, albeit small, increase in vancomycin trough levels in overweight or obese children dosed by TBW (mean difference 2.2 U).

Conclusions:

  • High-quality evidence for vancomycin dosing in pediatric obesity is limited.
  • Total body weight dosing may result in elevated vancomycin concentrations, increasing the risk of toxicity in children with overweight or obesity.
  • Further studies are essential to develop and validate optimized vancomycin dosing strategies for this growing pediatric population.
Abstract

More Related Videos

Author Spotlight: Exploring Venous Waveforms in Porcine Models to Tackle Volume Overload in Medicine06:09

Author Spotlight: Exploring Venous Waveforms in Porcine Models to Tackle Volume Overload in Medicine

Published on: January 12, 2024

946
Multidisciplinary Approach to Obesity Management: A Case Report05:10

Multidisciplinary Approach to Obesity Management: A Case Report

Published on: May 30, 2025

817

Related Concept Videos

Drug Dosing: Obese Patients01:21

Drug Dosing: Obese Patients

In the United States, obesity is a prominent concern. It is linked to heightened mortality rates due to increased occurrences of conditions such as hypertension, atherosclerosis, coronary artery disease, and diabetes compared to nonobese individuals. A patient is classified as obese if their actual body weight surpasses the ideal or desirable body weight by 20%, based on Metropolitan Life Insurance Company data. Ideal body weights consider average weights and heights for males and females...
165
Drug Dosing: Infants and Children01:29

Drug Dosing: Infants and Children

Pediatric patient dosages diverge from adults due to disparities in body surface area, total body water, and extracellular fluid per kilogram of body weight. The dosing regimen considers the variations in pharmacokinetics and pharmacology across distinct age groups, encompassing preterm newborns, infants, young children, older children, and adolescents. Calculation of pediatric patient doses is predicated on determining body surface area, which exhibits a superior correlation with the child's...
183
Pharmacokinetics in Pediatric Patients: Drug Metabolism01:24

Pharmacokinetics in Pediatric Patients: Drug Metabolism

In pediatric care, understanding the nuances of hepatic drug metabolism is crucial, as it significantly differs from that of adults. This divergence is primarily due to the developmental stage of drug-metabolizing enzymes, which affects how medications are processed in the body. In neonates, for instance, the activity of Phase I enzymes—critical for the initial breakdown of drugs—is markedly reduced, functioning at just 20–40% of the levels seen in adults. This reduction poses...
142
Pharmacokinetics in Obese Patients: Drug Metabolism and Excretion01:20

Pharmacokinetics in Obese Patients: Drug Metabolism and Excretion

Drug metabolism, a critical process in the liver, involves two primary phases: Phase I reactions and Phase II conjugation. Obesity introduces significant alterations in this metabolic process, primarily due to fatty infiltration of the liver, leading to conditions such as nonalcoholic fatty liver disease (NAFLD). This condition can modify the activities of both Phase I and II enzymes, impacting how drugs are metabolized in obese patients.Phase I metabolism sees variable effects across...
118
Pharmacokinetics in Obese Patients: Drug Absorption and Distribution01:25

Pharmacokinetics in Obese Patients: Drug Absorption and Distribution

Obesity significantly alters the pharmacokinetic processes of drug absorption and distribution, presenting unique challenges in medical treatment. The increased fat tissue and decreased lean muscle in obese individuals can significantly affect how drugs are absorbed into the body and distributed across different tissues. This alteration can lead to variances in the effectiveness and safety of medications, necessitating adjustments in dosing or drug selection for obese patients.One notable...
187
Pharmacokinetics in Pediatric Patients: Drug Excretion01:26

Pharmacokinetics in Pediatric Patients: Drug Excretion

In pediatric medicine, understanding the renal function and drug elimination nuances is crucial for administering safe and effective treatments. Newborns, in particular, display markedly slower renal functions than adults, profoundly affecting how drugs are cleared from their bodies. This slower drug clearance requires clinicians to extend the dosing intervals for many medications to prevent drug accumulation and toxicity while ensuring therapeutic efficacy.One key area where these adjustments...
153