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Evaluation of vancomycin initial trough levels in children: A 1-year retrospective study
Muhammad Salem1, Ahmed Khalil1, Asmaa Mohamed1
1Department of Pharmacy, Hamad Medical Corporation, Doha, Qatar.
Insights
Most children do not achieve therapeutic vancomycin levels, especially those aged 2-5 years. The standard 60 mg/kg/day dose is insufficient, necessitating further study into optimized pediatric dosing regimens.
Area of Science:
- Pediatric Pharmacology
- Infectious Diseases
- Antimicrobial Stewardship
Background:
- Achieving therapeutic vancomycin levels is crucial for effective treatment and preventing antibiotic resistance.
- Most pediatric patients fail to reach the recommended trough levels of 10-20 µg/mL.
Purpose of the Study:
- To determine the frequency of achieving therapeutic vancomycin initial trough levels in children.
- To evaluate the impact of age on vancomycin level achievement and mean trough concentrations.
- To assess the incidence of supratherapeutic vancomycin levels in pediatric patients.
Main Methods:
- A retrospective study included 75 children (1 month to 12 years) receiving vancomycin (15 mg/kg every 6 hours).
- Vancomycin trough levels were measured before the fourth dose.
- Exclusion criteria included high baseline creatinine, acute kidney injury, and congenital heart disease.
Main Results:
- Only 37.3% (28/75) of children achieved the target vancomycin levels.
- Children aged 2-5 years had the lowest achievement rate (21.4%) and significantly lower mean initial trough levels (7.3 µg/mL) compared to infants (10.1 µg/mL).
- No supratherapeutic vancomycin levels were detected.
Conclusions:
- The standard vancomycin dose of 60 mg/kg/day is inadequate for achieving therapeutic levels in most pediatric patients.
- Younger children, particularly those aged 2-5 years, are less likely to reach target levels.
- Prospective studies investigating intensified vancomycin dosing regimens are needed to optimize empiric treatment in children.
Background And Objectives:
Achieving vancomycin therapeutic levels is essential for antibacterial success and resistance prevention. Multiple studies have shown that most of the children fail to reach therapeutic trough levels (10-20 µg/mL). This study aims to determine the frequency of achieving therapeutic vancomycin initial trough levels in children, evaluate the effect of age on that achievement and the mean initial trough levels, and the frequency of supratherapeutic levels.
Methods:
Children aged 1 month to 12 years who received three or more vancomycin doses 15 mg/kg every 6 h while admitted at our hospital from February 2016 to January 2017, and had a level before the fourth dose were included. Cases with high baseline serum creatinine, acute kidney injury, and congenital heart disease were excluded.
Results:
Out of 75 included cases, one third, 28/75 (37.3%), achieved goal. The lowest frequency was 6/28 (21.4%) of the 2-5 years group, which were statistically less likely to achieve, and had significantly lower mean initial trough than the 1-23 months group (P = 0.026 and 0.013, respectively). Mean initial trough levels were 10.1, 7.3, and 8.2 µg/mL in the 1-23 months, 2-5 years, and 6-12 years groups, respectively (P = 0.014). No supratherapeutic levels were observed.
Conclusion:
Vancomycin dose of 60 mg/kg/day is insufficient to attain target levels for most of the children. Children aged 2-5 years are the least likely to achieve and have the lowest mean levels. More intensified doses are warranted to be studied prospectively to identify the most effective empiric dose for children.
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