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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.
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.
Abstract:
The purposes of this investigation were to characterize the disposition of vancomycin in children undergoing cardiopulmonary bypass (CPB) surgery and to determine whether a 15-mg/kg intravenous dose provides adequate serum concentrations during and after CPB. Six children (age range, 0.8 to 4.8 years) received intravenous vancomycin 15 mg/kg 1 to 2 hours before CPB surgery. Serial blood samples (mean, 10/patient) were collected before, during and after CPB surgery. The mean (+/- SD) vancomycin concentrations at the end of the infusion and 5 hours after the infusion were 27.3 +/- 5.7 and 5.9 +/- 3.0 mg/liter, respectively. The initiation of CPB resulted in an abrupt decrease (44.5%) in serum vancomycin concentrations; however, concentrations remained constant (range, 6.2 to 14.1 mg/liter) throughout the rest of the CPB procedure. The mean (+/- SD) values for the apparent volume of distribution, total body clearance and elimination half-life were 0.59 +/- 0.15 liter/kg, 2.94 +/- 0.93 ml/min/kg and 2.4 +/- 0.8 hours, respectively. These values were similar to those reported in the literature for children not undergoing CPB surgery. A single vancomycin dose of 15 mg/kg before pediatric CPB surgery provides serum concentrations greater than 5 mg/liter throughout the duration of the CPB procedure. To sustain these concentrations subsequent dosing of vancomycin is necessary within 6 hours after the initial vancomycin dose.