Related Experiment Video

Updated: Oct 16, 2025

Multiplex Therapeutic Drug Monitoring by Isotope-dilution HPLC-MS/MS of Antibiotics in Critical Illnesses
11:17

Multiplex Therapeutic Drug Monitoring by Isotope-dilution HPLC-MS/MS of Antibiotics in Critical Illnesses

Published on: August 30, 2018

13.0K

The relationship between vancomycin AUC/MIC and trough concentration, age, dose, renal function in Chinese critically

Jihui Chen1, Xiaohui Huang1, Shuhong Bu1

  • 1Department of Pharmacy, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.

Pharmacology Research & Perspectives
|October 19, 2021
PubMed

Insights

Vancomycin dosing in critically ill children requires careful consideration. Trough concentrations linked to therapeutic AUC24 are lower than in adults, and 60 mg/kg/day may be insufficient, especially with augmented renal clearance.

Area of Science:

  • Pharmacology
  • Pediatric Critical Care
  • Infectious Diseases

Background:

  • Vancomycin is crucial for treating serious Gram-positive infections in critically ill children.
  • Understanding vancomycin pharmacokinetics (PK) in pediatric intensive care units (PICU) is vital for optimizing therapy.
  • Pediatric PK parameters, including half-life and clearance, differ significantly from adults and vary with age.

Purpose of the Study:

  • To evaluate vancomycin PK parameters in Chinese critically ill pediatric patients.
  • To determine optimal vancomycin dosing strategies to achieve target exposure (AUC24/MIC ≥400).
  • To investigate the impact of augmented renal clearance (ARC) on vancomycin exposure.

Main Methods:

  • Prospective study of critically ill pediatric patients receiving vancomycin.
  • Serum vancomycin concentrations (peak and trough) measured on day 3 of treatment.
  • Analysis of PK parameters, including half-life, clearance, AUC24, and correlation with trough concentrations.

Main Results:

  • Vancomycin half-life was longer in neonates and decreased with age.
  • Higher vancomycin doses (60 mg/kg/day) increased the achievement of target AUC24/MIC.
  • Augmented renal clearance (ARC) was observed in 27.3% of patients, leading to higher clearance and lower AUC.
  • Trough concentrations correlated with AUC24, with specific targets identified for different dosing intervals.

Conclusions:

  • Vancomycin target trough concentrations for AUC24 of 400 are lower in critically ill children than adults.
  • A vancomycin dose of 60 mg/kg/day may be insufficient for achieving target AUC24 (400-600 mg·h/L) in critically ill children, particularly those with ARC.
  • Individualized vancomycin dosing and therapeutic drug monitoring are essential in this population.

Keywords:
area under the concentration-time curvepediatric patientspharmacokineticstrough concentrationvancomycin

More Related Videos

A Reference Broth Microdilution Method for Dalbavancin In Vitro Susceptibility Testing of Bacteria that Grow Aerobically11:28

A Reference Broth Microdilution Method for Dalbavancin In Vitro Susceptibility Testing of Bacteria that Grow Aerobically

Published on: September 9, 2015

29.2K
Quantification of the Immunosuppressant Tacrolimus on Dried Blood Spots Using LC-MS/MS08:38

Quantification of the Immunosuppressant Tacrolimus on Dried Blood Spots Using LC-MS/MS

Published on: November 8, 2015

17.1K

Related Concept Videos

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...
33
Estimation of k and VD of Aminoglycosides01:20

Estimation of k and VD of Aminoglycosides

Aminoglycosides are a class of antibiotics used to treat various bacterial infections. Clinicians must determine the elimination rate constant (k) and volume of distribution (VD) to optimize therapeutic efficacy and minimize toxicity. The k value represents the rate at which the drug is removed from the body, and the VD reflects the degree to which the drug distributes into body tissues. Accurately estimating these parameters allows healthcare professionals to tailor drug dosing to individual...
26
Pharmacokinetics in Geriatric Patients: Effect of Age on Drug Excretion01:18

Pharmacokinetics in Geriatric Patients: Effect of Age on Drug Excretion

In geriatric patients, renal physiology undergoes significant changes, including diminished renal blood flow and a lower glomerular filtration rate (GFR), leading to alterations in medication clearance. Drugs such as aminoglycoside antibiotics, lithium, and digoxin, which rely on glomerular filtration for removal from the body, particularly impact pharmacokinetics. These drugs tend to have slower clearance rates in older adults, necessitating careful dosage considerations.Evaluation of renal...
65
Determination of Multiple Dosing Parameters: Steady-State, Minimum and Maximum Concentrations01:15

Determination of Multiple Dosing Parameters: Steady-State, Minimum and Maximum Concentrations

Gentamicin, an aminoglycoside antibiotic, is commonly administered via intermittent intravenous infusion to treat severe infections. An intermittent one-hour infusion of gentamicin, administered at eight-hour intervals, allows for precise control of plasma drug concentrations, minimizing toxicity while ensuring therapeutic efficacy. Pharmacokinetic principles govern the dynamics of plasma concentrations and can be mathematically described using specific equations.The plasma drug concentration...
19
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...
34
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...
41