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An evaluation of the empirical vancomycin dosing guide in pediatric cardiology
Yousif S Alakeel1,2,3,4, Yazeed Alahmed5,6, Ghadah Alanazi7,5
1Department Pharmaceutical Care Services, King Abdulaziz Medical City, Ministry of the National Guard - Health Affairs, Riyadh, Saudi Arabia. alakeely@gmail.com.
Insights
Higher vancomycin doses are used due to resistance. This study found that the current dosing guide for vancomycin in pediatric cardiology resulted in subtherapeutic levels in infants, young children, and those undergoing cardiopulmonary bypass surgery.
Area of Science:
- Pediatric Cardiology
- Pharmacology
- Infectious Diseases
Background:
- Rising bacterial resistance necessitates higher vancomycin doses.
- Evaluating current vancomycin dosing guidelines in pediatric cardiac patients is crucial.
Purpose of the Study:
- To assess the efficacy and safety of the established vancomycin medication administration guide (MAG) in pediatric cardiology.
- To determine if the current MAG achieves therapeutic vancomycin serum concentrations in young cardiac patients.
Main Methods:
- A single-center prospective cohort study was conducted from June 2020 to March 2021.
- Included were pediatric cardiac patients under 14 years receiving intravenous vancomycin (40 mg/kg/day every 6-8 hours) for at least three days.
- Serum vancomycin levels were monitored to assess therapeutic range achievement.
Main Results:
- Out of 88 patients, 71.6% achieved therapeutic vancomycin levels (7-20 mg/L).
- Infants (29.2%), young children (54.2%), and those undergoing cardiopulmonary bypass (CPB) surgery (87.5%) showed higher rates of subtherapeutic levels.
- 8 (10%) patients had elevated serum creatinine (SCr), and 2 (2.5%) developed acute kidney injury (AKI); ACE inhibitor use was associated with lower SCr elevation incidence.
Conclusions:
- The current vancomycin medication administration guide (MAG) resulted in subtherapeutic serum concentrations in infants, young children, and CPB patients.
- Further investigation into strategies for preventing acute kidney injury (AKI) is warranted, as causes remain unidentified.
- The study highlights potential challenges in optimizing vancomycin dosing for specific pediatric cardiac populations.
Background:
Higher doses of vancomycin are currently prescribed due to the emergence of bacterial tolerance and resistance. This study aimed to evaluate the efficacy and safety of the currently adopted vancomycin dosing guide in pediatric cardiology.
Methods:
This was a single-center prospective cohort study with pediatric cardiac patients, younger than 14 years, from June 2020 to March 2021. The patients received intravenous vancomycin (40 mg/kg/day divided every 6-8 h) according to the department's vancomycin medication administration guide (MAG) for at least three days.
Results:
In total, 88 cardiac patients were included, with a median age of 0.82 years (IQR: 0.25-2.9), and 51 (58%) received cardiopulmonary bypass surgery (CPB). The majority (71.6%, n = 61) achieved a serum vancomycin level within the therapeutic range (7-20 mg/L). Infants, young children, and children exposed to CPB surgery had an increased incidence of subtherapeutic vancomycin levels, [7 (29.2%); P = 0.033], [13 (54.2%); P = 0.01], and [21 (87.5%); P = 0.009] respectively. After the treatment, 8 (10%) patients had an elevated Serum creatinine (SCr) and 2 (2.5%) developed acute kidney injury (AKI). However, no significant difference was found between the patients developing AKI or an elevated SCr and the group who did not, in terms of clinical, therapeutic, and demographic characteristics, except for the decreased incidence of SCr elevation in patients receiving an ACE inhibitor, [4 (36.4%); P = 0.036].
Conclusion:
Our institution followed MAG recommendations; however, subtherapeutic serum concentrations were evident in infants, young children, and CPB patients. Strategies to prevent AKI should be investigated, as the possible causes have not been identified in this study.
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