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

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.