Tailoring pediatric vancomycin doses: achieving therapeutic levels and minimizing toxicity in oncology patients

Vancomycin is a widely used nephrotoxic drug in pediatric oncology. Our aim was to assess the initial vancomycin dosing protocols required for achieving the target therapeutic concentrations of vancomycin between 10 and 20 mcg/ml.

We analyzed 4134 vancomycin trough levels from 1678 pediatric oncology patients treated at CCHE 57357 (2017-2023).

Higher initial Vancomycin doses (80 and 100 mg/kg/day) yielded better target levels (45.5%, 51.4%) compared to 60 mg/kg/day (38.1%). Younger patients (<10 years) showed higher sub-therapeutic levels than older ones (53.4% vs. 24.8%, p < 0.0001). Co-administration of nephrotoxic medications increased vancomycin toxicity risk (13.3% vs. 8.9%, p < 0.0001). Weight-based dosing of vancomycin resulted in higher therapeutic levels compared to capping doses at 500 mg.

Higher initial vancomycin doses (80-100 mg/kg/day) may be necessary to achieve therapeutic levels in pediatric oncology. Kg dosing beats capping for reaching targets without raising toxicity.