Evaluation of Vancomycin Dosing and Corresponding Drug Concentrations in Pediatric Patients

Abstract

The number of trough concentrations within the target range of 10 to 20 μg/mL was low, and younger patients often needed doses >60 mg/kg per day to achieve a trough concentration in this range. The dose of vancomycin was found to have a statistically significant effect on the ability to achieve a trough concentration within the target range.

The Impact of Pediatric-Specific Vancomycin Dosing Guidelines: A Quality Improvement Initiative

“…First, it has relatively small numbers and was conducted at a single clinical center, which limits its generalizability. However, as previously stated, several previous studies have found similar deficiencies in vancomycin practices based on retrospective analyses, 3 and, as a quality improvement project, these numbers should be sufficient to determine control limits and provide appropriate information regarding the stability of a process. A second limitation was the exclusion of patients with unpredictable volume of distribution, such as patients requiring vasopressor support, and patients with increased potential for nephrotoxicity, such as those with kidney disease, cystic fibrosis, and concomitant therapy with an aminoglycoside.…”

“…was 15 mg/kg every 6 hours for pediatric patients. 2 It is unclear, however, if the high trough goal can be reliably attained by using the suggested dosing 3,4 and if the use of higher doses will improve target attainment within a clinically appropriate time interval.…”

“…3,4,6,7,10 In studies using 15 mg/kg every 6 hours, only 6.76% 4 or 13% 7 had troughs between 15 and 20 µg/mL, and the average resultant trough was 10.7 µg/mL. 6 Another retrospective review by Geerlof and Boucher 3 found that only 31.7% of pediatric patients treated with 60 mg/kg per day had troughs between 10 and 20 µg/mL. Larger doses >60 mg/kg per day have therefore been proposed because low troughs may contribute to treatment failures and increased bacterial resistance.…”

Evaluation of vancomycin initial trough levels in children: A 1-year retrospective study

“…A therapeutic vancomycin initial trough level was defined as 10 to 20 µg/mL. 10,12,15 Pediatric inpatients aged 1 month to 12 years at the time of starting vancomycin which was received during the period from 1 February 2016 to 31 January 2017 were included. They must have received at least three vancomycin doses of 15 mg/kg/dose every 6 h (intended total daily dose of 60 mg/kg/day divided every 6 h).…”

“…Eligible patients were then categorized into three age groups for the secondary outcomes: Group (1): ⩾1 month to 23 months, group (2): 2-5.99 years, and group (3): 6-12.99 years. 10,12 For convenience, ages 2-5.99 and 6-12.99 years will be expressed all through as 2-5 and 6-12 years, respectively.…”