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Pharmacokinetics of intravenous vancomycin in pediatric cardiopulmonary bypass surgery

F K Hatzopoulos1, I L Stile-Calligaro, K A Rodvold

  • 1Department of Pharmacy Practice, College of Pharmacy, University of Illinois, Chicago 60612.

The Pediatric Infectious Disease Journal
|April 1, 1993
PubMed

Insights

A 15-mg/kg vancomycin dose in children undergoing cardiopulmonary bypass (CPB) surgery maintains adequate serum concentrations during the procedure. However, subsequent vancomycin dosing is needed within six hours to sustain therapeutic levels post-CPB.

Area of Science:

  • Pharmacology
  • Pediatric Surgery
  • Critical Care Medicine

Background:

  • Vancomycin is crucial for treating serious infections in children.
  • Cardiopulmonary bypass (CPB) surgery can alter drug pharmacokinetics, including vancomycin.
  • Understanding vancomycin disposition during CPB is vital for effective treatment.

Purpose of the Study:

  • To characterize vancomycin disposition in pediatric patients during CPB surgery.
  • To evaluate if a 15-mg/kg intravenous vancomycin dose ensures adequate serum concentrations throughout CPB.

Main Methods:

  • Six pediatric patients (0.8-4.8 years) received a 15-mg/kg intravenous vancomycin dose before CPB.
  • Serial blood samples were collected pre-, during, and post-CPB for vancomycin concentration analysis.
  • Pharmacokinetic parameters (volume of distribution, clearance, half-life) were calculated.

Main Results:

  • CPB initiation caused a 44.5% drop in vancomycin levels; concentrations stabilized between 6.2-14.1 mg/liter during CPB.
  • Mean vancomycin concentrations were 27.3 mg/liter at infusion completion and 5.9 mg/liter at 5 hours post-infusion.
  • Calculated pharmacokinetic parameters were comparable to those in children not on CPB.

Conclusions:

  • A single 15-mg/kg pre-CPB vancomycin dose achieves concentrations >5 mg/liter during the procedure.
  • To maintain therapeutic vancomycin levels, re-dosing is necessary within 6 hours of the initial dose.
  • This study informs optimized vancomycin dosing strategies in pediatric CPB patients.

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