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Published on: August 30, 2018
Effect of Initial Vancomycin Dose and Creatinine Clearance on the Attainment of Target Trough Concentration in
Ha Manh Tuan1, Nguyen Tuan Anh2, Kim Tran Quan3
1University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam.
Insights
Therapeutic drug monitoring for vancomycin is crucial in Vietnamese children. While creatinine clearance influences vancomycin levels, dose adjustments alone may not guarantee target trough attainment, necessitating routine monitoring.
Area of Science:
- Pharmacology
- Pediatric Infectious Diseases
- Clinical Pharmacy
Background:
- Vancomycin is a critical antibiotic for severe gram-positive infections.
- Routine therapeutic drug monitoring (TDM) for vancomycin is lacking in Vietnamese clinical practice.
- TDM ensures vancomycin efficacy and patient safety.
Purpose of the Study:
- To investigate the relationship between initial vancomycin dose, creatinine clearance, and target trough levels in hospitalized Vietnamese children.
- To assess the impact of dose adjustments based on creatinine clearance on achieving therapeutic vancomycin concentrations.
Main Methods:
- Prospective study involving hospitalized children receiving vancomycin for at least three days.
- Collection of demographic data, clinical information, vancomycin dosage, and serum creatinine levels.
- Calculation of creatinine clearance and adjusted vancomycin doses, with subsequent trough level measurement.
Main Results:
- Forty pediatric patients were analyzed, with a mean age of 1.4 years.
- Creatinine clearance significantly influenced initial and adjusted vancomycin doses (p < 0.05).
- No statistically significant correlation was found between creatinine clearance groups and trough vancomycin concentrations (p = 0.406).
Conclusions:
- Vancomycin trough levels in children may be linked to creatinine clearance but not always proportionally to the prescribed dose.
- Routine monitoring of vancomycin trough levels is essential for optimizing treatment and ensuring safety in pediatric patients.
- This study highlights the need for TDM in Vietnamese pediatric populations to manage vancomycin therapy effectively.
Background:
Vancomycin is a glycopeptide antibiotic that is used to treat serious grampositive infections. However, therapeutic drug monitoring for vancomycin is not performed routinely in Vietnam in clinical practices. Monitoring of serum vancomycin concentration or trough levels is necessary to ensure the efficacy and safety of vancomycin therapy.
Objective:
This study aims to determine the impact of initial vancomycin dose and creatinine clearance on target trough attainment in hospitalized Vietnamese children.
Methods:
A prospective study with patients who received vancomycin for at least three days was conducted. Subsequently, demographic data, clinical diagnosis, vancomycin dosage, and serum creatinine levels were recorded. The vancomycin trough level was collected and creatinine clearance and adjusted vancomycin doses were calculated.
Results:
A total of 40 eligible patients were enrolled. Patients' mean age, body weight, and height were 1.4 years old, 9.8 kg, and 75.5 cm, respectively. The mean vancomycin dose was 55.83 ± 19.34 mg/kg/day. The mean creatinine clearance was 80.18 ± 29.14 ml/min. The median trough level was 11.09 (7.84 - 16.46) μg/ml. There was no significant difference in the mean initial and the adjusted vancomycin doses (p = 0.062). However, there were statistically significant differences of initial (p = 0.004) or adjusted doses (p = 0.016) between groups of creatinine clearance. The trough vancomycin concentration was not statistically significant (p = 0.406) between these groups.
Conclusion:
Target trough vancomycin level may be associated with creatinine clearance but did not proportionally correspond to the vancomycin dose. Therefore, monitoring vancomycin trough levels is necessary to achieve the target trough and to ensure vancomycin efficacy and safety in treating severely infected Vietnamese children.
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