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Practical approaches to improve vancomycin-related patient outcomes in pediatrics- an alternative strategy when

Kashif Hussain1, Muhammad Sohail Salat2, Shahzad Rauf2

  • 1Department of Pharmacy, Aga Khan University Hospital, Stadium Road (Main Pharmacy), P.O Box 3500, Karachi, 74800, Pakistan. Kashif.hussain@aku.edu.

BMC Pharmacology & Toxicology
|August 20, 2022
PubMed

Insights

Higher vancomycin doses (72 mg/kg/day) are needed for pediatric patients to reach therapeutic levels, improving outcomes without increasing nephrotoxicity. Pharmacist interventions are key for optimizing vancomycin therapy in children.

Area of Science:

  • Pediatric Pharmacology
  • Infectious Diseases
  • Clinical Pharmacy

Background:

  • Most pediatric patients do not achieve target vancomycin trough levels (VTLs) with standard dosing regimens.
  • Higher total daily doses (TDD) are often required to reach therapeutic VTLs in children.
  • This study evaluates vancomycin dosing in hospitalized pediatric patients.

Purpose of the Study:

  • To determine the frequency of achieving target VTLs in pediatric patients with a vancomycin (VNCO) regimen of 40-60 mg/kg/d q6h.
  • To assess the VNCO-TDD needed to attain target VTLs.
  • To evaluate the impact of VNCO-TDD on clinical outcomes in pediatric patients.

Main Methods:

  • Retrospective chart review of 3-month to 12-year-old patients receiving vancomycin.
  • Data collected included demographic and clinical characteristics, VTLs, VNCO-regimen, and serum creatinine.
  • Clinical pharmacist interventions and safety outcomes (nephrotoxicity, length of stay, survival) were assessed.

Main Results:

  • Only 39.1% of patients achieved target VTLs with standard dosing; 60.9% required higher TDD (72 ± 8.9 mg/kg/d q6h).
  • Patients receiving higher TDD had significantly shorter duration of therapy, hospital stay, and higher survival rates.
  • Nephrotoxicity and electrolyte imbalance were comparable between standard and higher dose groups.

Conclusions:

  • Initial vancomycin doses of 72 mg/kg/day q6h are necessary to achieve therapeutic targets in pediatric patients (3 months-12 years).
  • Higher vancomycin doses are not associated with increased nephrotoxicity compared to lower doses.
  • Pharmacist-driven interventions using higher VNCO-TDD can improve clinical outcomes, including duration of therapy, hospital stay, and survival.
Abstract

Keywords:
AUCPakistanPediatricsVancomycinVancomycin trough level

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