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Related Experiment Videos

Changes in vancomycin pharmacokinetics in critically ill infants

A G Gous1, M D Dance, J Lipman

  • 1Department of Pharmacy, University of the Witwatersrand, Johannesburg, South Africa.

Anaesthesia and Intensive Care
|December 1, 1995
PubMed
Summary

Critically ill infants receiving vancomycin show significant pharmacokinetic changes, particularly a larger initial volume of distribution (Vd). This highlights the need for therapeutic drug monitoring in this specific population.

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Area of Science:

  • Pharmacokinetics
  • Critical Care Medicine
  • Pediatric Pharmacology

Background:

  • Vancomycin is crucial for treating serious infections in infants.
  • Standard dosing regimens may not be optimal for critically ill infants due to altered physiology.

Purpose of the Study:

  • To assess vancomycin pharmacokinetics in critically ill infants.
  • To evaluate the efficacy of the standard recommended dose of 10 mg/kg every 6 hours.

Main Methods:

  • Prospective study of infants in an Intensive Care Unit (ICU) receiving vancomycin.
  • Serum vancomycin concentrations were measured on days 2 and 8 of therapy.
  • Key pharmacokinetic parameters including volume of distribution (Vd), peak concentration (Cmax), and half-life (t1/2el) were determined.

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Main Results:

  • The mean vancomycin volume of distribution (Vd) was significantly larger on day 2 (0.81 L/kg) compared to day 8 (0.44 L/kg).
  • This change in Vd led to significant alterations in mean Cmax and t1/2el over the treatment period.
  • Aggressive fluid resuscitation in critically ill infants likely contributed to the large initial Vd and pharmacokinetic variability.

Conclusions:

  • Critically ill infants exhibit significant pharmacokinetic variability, especially a large initial Vd.
  • This variability suggests that routine therapeutic drug monitoring of vancomycin serum levels is indicated in this specific patient group.
  • Individualized dosing adjustments may be necessary to ensure optimal vancomycin therapy in critically ill infants.