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Vancomycin pharmacokinetics in neonates receiving extracorporeal membrane oxygenation
1Department of Pharmacy, Children's Medical Center, School of Medicine, University of Virginia, Charlottesville, USA.
Pharmacotherapy
|October 3, 1998
Summary
Vancomycin dosing in neonates on extracorporeal membrane oxygenation (ECMO) requires longer intervals than typically recommended. This study found altered pharmacokinetics in neonates undergoing ECMO, suggesting adjusted vancomycin regimens are necessary for optimal treatment.
Area of Science:
- Neonatal pharmacology
- Critical care medicine
- Pharmacokinetics
Background:
- Vancomycin is crucial for treating and preventing infections in neonates undergoing extracorporeal membrane oxygenation (ECMO).
- Standard vancomycin dosing may not be appropriate for neonates on ECMO due to altered physiological parameters.
Purpose of the Study:
- To determine optimal vancomycin dosing strategies for neonates receiving ECMO.
- To compare pharmacokinetic parameters of vancomycin in neonates with and without ECMO.
Main Methods:
- An open-label, retrospective study of neonates receiving vancomycin during ECMO.
- Pharmacokinetic analysis including volume of distribution, half-life, and clearance.
- Comparison with matched control neonates not on ECMO.
Main Results:
- Neonates on ECMO exhibited a longer vancomycin half-life (8.29 ± 2.23 hours) compared to controls (6.53 ± 2.05 hours).
- Volume of distribution and clearance were not significantly different between ECMO recipients and controls.
- The common regimen of 10 mg/kg every 8 hours yielded variable peak and trough concentrations.
Conclusions:
- Empiric vancomycin regimens for neonates on ECMO should incorporate longer dosing intervals than the standard 6-8 hours.
- Altered pharmacokinetics, particularly a prolonged half-life, necessitate individualized dosing adjustments.
- Further research is needed to assess the impact of illness severity on vancomycin elimination in this population.
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