Nephrotoxicity With Vancomycin in the Pediatric Population

Fiorito, Theresa M.; Luther, Megan K.; Dennehy, Penelope H.; LaPlante, Kerry L.; Matson, Kelly L.

doi:10.1097/inf.0000000000001882

Cited by 58 publications

(51 citation statements)

References 37 publications

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“…Recently, a revised consensus guideline developed by different scientific associations has been published, recommending a target of an AUC/MIC ratio of 400 to 600 (assuming a MIC of 1 mg/L) for empiric dosing in both adult and pediatric patients to maximize clinical efficacy and minimize nephrotoxicity [ 5 ]. However, there is a lack of evidence for this parameter in children due to the complexity of vancomycin clearance in the various pediatric age groups, and the differences in tissue site-of-infection drug exposure as a consequence of higher pharmacokinetic variability [ 5 , 6 ]. Due to the impracticalities of calculating the AUC, target trough concentrations of 15 to 20 mg/L are used as a surrogate marker in adults with normal renal function when MIC is ≤1 mg/mL [ 7 , 8 ].…”

Section: Introductionmentioning

confidence: 99%

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Efficacy and Safety of Continuous Infusion of Vancomycin in Children: A Systematic Review

et al. 2021

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Vancomycin is used to treat a wide variety of infections within the pediatric population. In adults, continuous infusion of vancomycin (CIV) has been evaluated as an alternative to intermittent infusion of vancomycin (IIV) with potential advantages. In children, the use of CIV is increasing; however, data is currently limited. The objective is to provide efficacy and safety evidence for CIV within this population. The review was carried out following PRISMA guidelines. A bibliographic search was performed for studies on PubMed and EMBASE. Clinical trials and observational studies that reported clinical efficacy and/or target attainment of CIV in pediatrics were included. Articles were reviewed to assess their design and target population, characteristics of vancomycin treatment and the main findings in terms of safety and efficacy. A total of 359 articles were identified, of which seven met the inclusion criteria. All of them evaluated the target attainment, six assessed safety but only three assessed clinical efficacy. The best administration method for this antibiotic within the pediatric population is still unknown due to limited evidence. However, studies conducted thus far suggest pharmacokinetic advantages for CIV. Further investigation is required, in particular for studies comparing IIV with CIV for clinical efficacy and toxicity outcomes.

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Section: Introductionmentioning

confidence: 99%

“…When compared to adults, achieving therapeutic serum vancomycin concentrations (SVCs) with IIV in children requires higher doses and shorter intervals given their increased renal clearance [ 9 , 13 ]. However, higher doses have also been associated with increased nephrotoxicity in pediatrics [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

Efficacy and Safety of Continuous Infusion of Vancomycin in Children: A Systematic Review

et al. 2021

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“…Nephrotoxicity is often defined as an increase in serum creatinine of >50% from baseline . Factors that are associated with nephrotoxicity in adults and children are vancomycin trough concentrations over 15 mg/L and concomitant use of nephrotoxic medications …”

Section: Introductionmentioning

confidence: 99%

Vancomycin therapeutic drug monitoring in paediatrics

Patel

Lucas

Ryan

et al. 2019

J Paediatrics Child Health

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Aim: Vancomycin guidelines for therapeutic drug monitoring (TDM) aim to maximise efficacy while minimising toxicity and resistance. Vancomycin is effective against Staphylococcus aureus when it achieves area under the concentration-time curve (AUC)/minimum inhibitory concentration (MIC) > 400. Studies in children have shown that target trough concentrations poorly correlate to AUC/MIC > 400; however, they are used in practice for clinical convenience. This review in paediatric inpatients aims to audit performance against TDM guidelines and consider what changes are needed to optimise vancomycin monitoring. Methods: Vancomycin prescriptions in patients younger than 18 years old were collected over a 15-month period. Primary outcome measures were vancomycin initial dose (mg/kg/day) and the timing and result of first trough concentration (mg/L). Secondary outcome measures were the numbers achieving recommended targets and whether appropriate dose adjustments were made in response to TDM. Results: A total of 133 courses reached the time when TDM should occur. Average patient age was 6.5 years, and the average initial dose was 52.55 mg/kg/day (range 19.05-86.54 mg/kg). Only 25% of courses (n = 34) had a trough concentration measured at the recommended time. The mean trough concentration was 11.6 mg/L (range < 2.0-39.7). Of 40 patients with a low trough concentration, 50% continued without dose adjustment. Conclusion: As shown in the literature, there is a poor correlation between the vancomycin dose given and the trough concentration achieved. Given that recommendations for trough concentration monitoring are designed to simplify the process yet are poorly adhered to, a strategic plan to address these issues is needed.

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“…The strongest level of evidence in children is the association of acute kidney injury with higher vancomycin exposure, especially with troughs exceeding 15 to 20 mg/L. 6 In addition, one pediatric study found an AUC exposure of greater than 800 mg × h/L over 24 hours was strongly associated with risk for acute kidney injury. 7 These findings suggest that high vancomycin exposure correlates with nephrotoxicity, so with AUC monitoring, the goal exposure should be less than 800 mg × hr/L over 24 hours.…”

Section: Key Recommendations For Pediatric Hospitalistsmentioning

confidence: 99%

Clinical Guideline Highlights for the Hospitalist: Therapeutic Monitoring of Vancomycin

Murphy

Girdwood

Scheetz

2020

Journal of Hospital Medicine

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GUIDELINE TITLE: Therapeutic monitoring of vancomycin for serious methicillin-resistant Staphylococcus aureus infections: A revised consensus guideline and review by the American Society of Health-System Pharmacists, the Infectious Diseases Society of America, the Pediatric Infectious Diseases Society, and the Society of Infectious Diseases Pharmacists RELEASE DATE: Online: March 19, 2020 PRIOR VERSION: 2009 DEVELOPERS: American Society of Health-System Pharmacists (ASHP), the Infectious Diseases Society of America (IDSA), the Pediatric Infectious Diseases Society (PIDS), and the Society of Infectious Diseases Pharmacists (SIDP) FUNDING SOURCE: ASHP, IDSA, PIDS, SIDP TARGET POPULATION: Adults, children, and neonates treated for documented or presumed methicillin-resistant Staphylococcus aureus infection

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Nephrotoxicity With Vancomycin in the Pediatric Population

Abstract: Though the rate of vancomycin-induced nephrotoxicity is increased in pediatric patients with higher vancomycin troughs, other factors such as intensive care unit admission, hypovolemia and concurrent nephrotoxic drug use appear to contribute to the development of nephrotoxicity.

Cited by 58 publications

References 37 publications

Efficacy and Safety of Continuous Infusion of Vancomycin in Children: A Systematic Review

Efficacy and Safety of Continuous Infusion of Vancomycin in Children: A Systematic Review

Vancomycin therapeutic drug monitoring in paediatrics

Clinical Guideline Highlights for the Hospitalist: Therapeutic Monitoring of Vancomycin

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