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Characterization of Sickling During Controlled Automated Deoxygenation with Oxygen Gradient Ektacytometry
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Published on: November 5, 2019

Comparison of Vancomycin Trough Concentrations in Pediatric Patients with and without Sickle Cell Disease: A Cohort

Sohail Azam1, Kholoud Alrashed2, Muna Almijmaj2

  • 1Inpatient Pharmacy Department (SA, FEH), Dr. Sulaiman Al Habib Hospital, Riyadh.

The Journal of Pediatric Pharmacology and Therapeutics : JPPT : the Official Journal of PPAG
|August 11, 2026
PubMed

Insights

Pediatric patients with sickle cell disease (SCD) have lower vancomycin levels and need higher doses. This highlights the need for tailored dosing and monitoring in SCD patients to ensure effective treatment.

Area of Science:

  • Pharmacology
  • Pediatric Nephrology
  • Infectious Diseases

Background:

  • Sickle cell disease (SCD) is linked to altered kidney function, potentially increasing vancomycin clearance.
  • Subtherapeutic vancomycin levels may occur in pediatric SCD patients due to increased drug clearance.
  • Limited data exists on vancomycin pharmacokinetics in non-intensive care unit (ICU) pediatric SCD patients.

Purpose of the Study:

  • To compare vancomycin trough concentrations between pediatric patients with and without SCD.
  • To evaluate vancomycin dosing requirements in pediatric patients with and without SCD.
  • To investigate the impact of SCD on vancomycin pharmacokinetics in non-ICU pediatric patients.

Main Methods:

  • A retrospective cohort study compared pediatric non-ICU patients with SCD (n=29) and without SCD (n=58) from 2014-2024.
  • Assessed initial and repeated vancomycin trough concentrations, dosing regimens, and renal function.
  • Utilized multiple regression to identify predictors of vancomycin trough concentrations.

Main Results:

  • SCD patients had significantly lower initial vancomycin trough concentrations (5.43 ± 2.61 mg/L) compared to non-SCD patients (10.62 ± 4.71 mg/L; p < 0.00001).
  • Even after dose adjustments, troughs remained lower in SCD patients (10.30 ± 3.61 mg/L vs. 13.10 ± 3.73 mg/L; p = 0.0023).
  • SCD patients required higher adjusted daily doses (64.2 ± 10.0 mg/kg/day) than non-SCD patients (58.3 ± 12.0 mg/kg/day). SCD status independently predicted lower troughs (β = -4.40; p < 0.001).

Conclusions:

  • Pediatric SCD patients exhibit lower serum vancomycin trough concentrations.
  • Higher vancomycin dosing is necessary to achieve therapeutic targets in pediatric SCD patients.
  • Individualized dosing and early therapeutic drug monitoring are crucial for optimizing vancomycin efficacy in pediatric SCD patients.
Abstract

Keywords:
PediatricsPharmacokineticsSickle cell diseaseTherapeutic drug monitoringTrough concentrationsVancomycin

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