Achieving Vancomycin Troughs Within Goal Range in Low Birth Weight Neonates

Area of Science:

• Neonatal Pharmacology
• Infectious Diseases in Neonates
• Critical Care Medicine

Background:

• Vancomycin is a critical antibiotic for treating Gram-positive bacterial infections in neonates.
• Optimal vancomycin dosing in low birth weight (LBW) neonates remains undefined, posing therapeutic challenges.
• Achieving target vancomycin trough concentrations is crucial for efficacy and minimizing toxicity.

Purpose of the Study:

• To evaluate the achievement of target vancomycin trough concentrations (10-20 mg/L) with empiric dosing in critically ill LBW neonates.
• To identify the frequency of subtherapeutic and supratherapeutic vancomycin levels in this vulnerable population.

Main Methods:

• Retrospective review of LBW infants (<2500 g) admitted to a level IV NICU between January 2015 and December 2016.
• Inclusion criteria required a vancomycin trough sample at steady state (after at least 3 doses).
• Patients were categorized into subtherapeutic (<10 mg/L), therapeutic (10-20 mg/L), and supratherapeutic (>20 mg/L) trough cohorts for analysis.

Main Results:

• Only 36.5% (27/74) of LBW neonates achieved therapeutic vancomycin trough concentrations.
• A significant majority experienced subtherapeutic levels (54.1%, 40/74), with 9.5% (7/74) having supratherapeutic levels.
• While initial doses were similar, initial dosing frequency differed significantly between trough cohorts (p=0.04).

Conclusions:

• Current empiric vancomycin dosing regimens are inadequate for achieving target therapeutic troughs in the majority of LBW neonates.
• This highlights a critical need for revised and individualized dosing strategies to ensure effective vancomycin therapy in LBW infants.