Related Experiment Video
Updated: Dec 5, 2025
A Reference Broth Microdilution Method for Dalbavancin In Vitro Susceptibility Testing of Bacteria that Grow Aerobically
Published on: September 9, 2015
Does vancomycin administered at an empirical dose ensure coverage of pediatric patients against gram-positive
Frederico Ribeiro Pires1, Stefano Ivani de Paula1, Artur Figueiredo Delgado1
1Centro de Terapia Intensiva Pediátrica, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo - São Paulo (SP), Brasil.
Insights
Vancomycin effectiveness against gram-positive pathogens in pediatric intensive care units was suboptimal, with only 46% coverage. Altered pharmacokinetics necessitate a higher empirical dose and AUC/MIC ratio monitoring for improved vancomycin outcomes.
Area of Science:
- Pharmacology
- Pediatric Intensive Care
- Infectious Diseases
Background:
- Vancomycin is a critical antibiotic for treating gram-positive infections.
- Optimizing vancomycin dosing in pediatric intensive care units (PICUs) is challenging due to altered pharmacokinetics.
- Assessing vancomycin effectiveness requires consideration of pharmacokinetic/pharmacodynamic (PK/PD) targets.
Purpose of the Study:
- To evaluate vancomycin effectiveness in pediatric patients based on achieving a target area under the curve to minimum inhibitory concentration (AUC/MIC) ratio > 400.
- To investigate the impact of age on vancomycin pharmacokinetics and antimicrobial coverage in PICU patients.
- To determine optimal vancomycin dosing strategies for pediatric patients with preserved renal function.
Main Methods:
- A cohort of 22 pediatric patients in the PICU with preserved renal function was studied.
- Patients were stratified into two age groups (< 7 years and ≥ 7 years).
- Vancomycin pharmacokinetics and serum concentrations were measured after the fourth dose to assess antimicrobial coverage.
Main Results:
- Vancomycin coverage against gram-positive pathogens with MIC of 1mg/L was achieved in only 46% of patients.
- Pharmacokinetics were altered in both groups compared to reference values.
- Younger pediatric patients exhibited more pronounced increases in total body clearance and shorter biological half-lives.
Conclusions:
- An empirical vancomycin dose of 60mg/kg/day is recommended for pediatric ICU patients with preserved renal function.
- Using the AUC/MIC ratio is crucial for evaluating vancomycin coverage and ensuring therapeutic success.
- Altered pharmacokinetics in pediatric patients necessitate careful monitoring and dose adjustments to optimize vancomycin effectiveness.
Objective:
To investigate the vancomycin effectiveness against gram-positive pathogens with the minimum inhibitory concentration of 1mg/L in pediatric patients based on the area under the curve and the minimum inhibitory concentration ratio > 400.
Methods:
A population of 22 pediatric patients (13 boys) admitted to the pediatric intensive care unit with preserved renal function was stratified in two groups (G1 < 7 years and G2 ≥ 7 years). After the fourth dose administered of vancomycin (10 - 15mg/kg every 6 hours) was administered, two blood samples were collected (third and fifth hours), followed by serum measurement by immunoassays to investigate the pharmacokinetics and antimicrobial coverage.
Results:
There was no difference between the groups regarding dose, trough level or area under the curve. Coverage against gram-positive pathogens with a minimum inhibitory concentration of 1mg/L occurred in only 46% of patients in both groups. The pharmacokinetics in both groups were altered relative to the reference values, and the groups differed in regard to increased total body clearance and shortening of the biological half-life, which were more pronounced in younger patients.
Conclusion:
A minimum empirical dose of 60mg/kg per day should be prescribed for pediatric patients in intensive care units with preserved renal function. The use of the ratio between the area under the curve and minimum inhibitory concentration in the evaluation of vancomycin coverage is recommended to achieve the desired outcome, since the pharmacokinetics are altered in these patients, which may impact the effectiveness of the antimicrobial.
Related Concept Videos
01:26Pharmacokinetics in Pediatric Patients: Drug Excretion
01:29Drug Dosing: Infants and Children
01:24Pharmacokinetics in Pediatric Patients: Drug Metabolism
01:23Pharmacokinetics in Pediatric Patients: Overview and Drug Absorption
01:20Estimation of k and VD of Aminoglycosides
01:17Pharmacokinetics in Pediatric Patients: Drug Distribution