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Impact of the Implementation of a Vancomycin Protocol on Trough Serum Vancomycin Concentrations in a Pediatric

Raíssa Queiroz Rezende1, Cícero Armídio Gomes Dias2, Claudia Pires Ricachinevsky3

  • 1Pediatric Intensive Care Unit, Hospital da Criança Santo Antônio, Irmandade Santa Casa de Misericórdia de Porto Alegre, Unidade de Terapia Intensiva Pediátrica, Avenida Independência, 155, Porto Alegre, RS, CEP 90035-074, Brazil. raissaq@gmail.com.

Paediatric Drugs
|April 8, 2021
PubMed

Insights

Implementing a vancomycin protocol in pediatric intensive care improved the achievement of target serum concentrations within five days. This demonstrates the protocol

Area of Science:

  • Pediatric Intensive Care Medicine
  • Pharmacology
  • Infectious Diseases

Background:

  • Vancomycin is crucial in pediatric intensive care but challenging to use safely and effectively.
  • Optimizing vancomycin therapy is essential for treating serious infections in critically ill children.

Purpose of the Study:

  • To evaluate the impact of a clinical practice protocol on vancomycin trough serum concentrations in pediatric intensive care patients.
  • To assess if the protocol improved the achievement of target vancomycin levels.

Main Methods:

  • A retrospective quasiexperimental study compared patients before and after a 2017 vancomycin protocol implementation.
  • The study included pediatric patients (≤18 years) receiving vancomycin for ≥5 days.
  • Key metrics included initial dose, target serum levels (15-20 μg/mL), and achievement rates over time.

Main Results:

  • The post-protocol group showed a higher, though not statistically significant, initial achievement of target vancomycin levels (21.5% vs. 10.8%).
  • However, the proportion of patients achieving target levels within the first five days significantly increased from 52.3% to 73.8% after protocol implementation (p=0.018).
  • The protocol also appeared to reduce variability in vancomycin levels between the first and fifth day of treatment.

Conclusions:

  • Achieving therapeutic vancomycin trough concentrations in critically ill pediatric patients remains a significant clinical challenge.
  • Clinical practice protocols, even without advanced monitoring, can enhance dose adjustment and therapeutic control.
  • The study highlights the benefit of structured protocols in optimizing vancomycin use in pediatric intensive care settings.
Abstract

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