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Updated: Jun 25, 2025

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

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Association between prolonged vancomycin infusion and trough concentrations in children. Retrospective study

Jiru Li1, Yueniu Zhu1, Xiaodong Zhu1

  • 1Department of Pediatric Critical Care Medicine, Xinhua Hospital, Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China.

Archivos Argentinos De Pediatria
|May 31, 2024
PubMed

Insights

Prolonged infusion (PI) of vancomycin in children with severe infections achieved higher serum trough concentrations and target attainment rates compared to standard intermittent infusion (SII). This optimized vancomycin dosing strategy improved therapeutic efficacy without increasing adverse events.

Area of Science:

  • Pediatric Infectious Diseases
  • Pharmacokinetics and Pharmacodynamics
  • Critical Care Medicine

Background:

  • Vancomycin is a critical antibiotic for treating serious Gram-positive bacterial infections in children.
  • Optimizing vancomycin dosing is essential to achieve therapeutic efficacy and minimize toxicity.
  • Standard intermittent infusion (SII) may lead to suboptimal vancomycin serum concentrations in pediatric patients.

Purpose of the Study:

  • To compare serum vancomycin concentrations between standard intermittent infusion (SII) and prolonged infusion (PI) strategies in pediatric patients.
  • To evaluate the impact of different infusion strategies on vancomycin target attainment rates.
  • To assess the safety and efficacy of prolonged infusion vancomycin in children with severe infections.

Main Methods:

  • Retrospective cohort study of pediatric patients receiving vancomycin.
  • Patients divided into standard intermittent infusion (SII) and prolonged infusion (PI) groups.
  • Comparison of demographic data, vancomycin trough and peak concentrations, creatinine levels, and clinical outcomes.

Main Results:

  • Prolonged infusion (PI) resulted in significantly higher vancomycin trough concentrations (11.2 mg/L vs. 7 mg/L) and target attainment rates (59.4% vs. 19.3%) compared to standard intermittent infusion (SII).
  • No significant differences were observed in peak vancomycin concentrations, renal function (creatinine levels), duration of therapy, or PICU stay between the groups.
  • Multivariable analysis confirmed that prolonged infusion was associated with higher trough serum concentrations (OR = 2.27).

Conclusions:

  • Prolonged infusion (PI) vancomycin is an effective strategy for achieving therapeutic trough concentrations in children with severe infections.
  • The PI strategy may offer an optimized approach to vancomycin dosing in pediatric critical care.
  • Further prospective studies are warranted to confirm these findings and evaluate long-term outcomes.

Keywords:
acute kidney injurychildpharmacokineticsvancomycin, administration and dosage

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