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Dose optimization and target attainment of vancomycin in children

Alessia Cafaro1, Manuela Stella2, Alessio Mesini3

  • 1Chromatography and Mass Spectrometry Section, Central Laboratory of Analysis, IRCCS Istituto Giannina, Gaslini, Genova, Italy.

Clinical Biochemistry
|February 7, 2024
PubMed

Insights

Optimizing vancomycin dosing in children is crucial. Area under the curve (AUC)-guided therapeutic drug monitoring (TDM), especially with Bayesian forecasting, improves drug efficacy and safety in pediatric patients.

Area of Science:

  • Pharmacology
  • Pediatric Infectious Diseases
  • Clinical Pharmacy

Background:

  • Vancomycin, a key antibiotic for gram-positive infections, has been used for over 70 years.
  • Optimal dosing and pharmacokinetic/pharmacodynamic (PK/PD) target attainment in pediatric populations remain challenging.
  • Current therapeutic drug monitoring (TDM) practices in children require refinement for vancomycin therapy.

Purpose of the Study:

  • To review current literature on vancomycin use in pediatric patients.
  • To summarize knowledge on optimizing vancomycin dosing for target attainment in special pediatric populations.
  • To highlight the benefits of AUC-guided TDM and Bayesian forecasting for vancomycin therapy in children.

Main Methods:

  • Literature review of pediatric vancomycin studies.
  • Analysis of pharmacokinetic/pharmacodynamic (PK/PD) data in children.
  • Evaluation of therapeutic drug monitoring (TDM) strategies, including AUC-guided and trough-only monitoring.
  • Assessment of Bayesian forecasting for predicting vancomycin exposure.

Main Results:

  • Area under the curve (AUC)-guided TDM is recommended over trough-only TDM for vancomycin in children.
  • AUC-guided TDM enhances PK/PD target attainment (AUC0-24h/MIC > 400–600) and reduces acute kidney injury risk.
  • Bayesian forecasting improves the accuracy of predicting individual vancomycin concentrations and total exposure in pediatric patients.

Conclusions:

  • AUC-guided TDM, ideally incorporating Bayesian forecasting, is suggested for all pediatric age groups and special populations.
  • This approach optimizes vancomycin efficacy and safety, ensuring better therapeutic outcomes.
  • Further research and clinical implementation of advanced TDM strategies are warranted for pediatric vancomycin therapy.

Keywords:
ChildrenDrug MonitoringPediatric PharmacologyPharmacokineticsVancomycin

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