Abstract
ABSTRACTObjective Analyze the microbiological effectiveness, based on the pharmacokinetics/pharmacodynamics correlation of vancomycin in pediatric patients, and to propose dose adjustment.Methods This is an observational, cross-sectional study, conducted in a pediatric hospital, over a 1-year period (2016 to 2017). Children of both sexes, aged 2 to 12 years, were included in the study; burn children, and children in renal replacement therapy were excluded. For the pharmacokinetic analysis, two samples of 2mL of whole blood were collected, respecting the 2-hour interval between each withdrawal.Results Ten pediatric patients with median age of 5.5 years and interquartile range (IQR) of 3.2-9.0 years, median weight of 21kg (IQR: 15.5-24.0kg) and median height of 112.5cm (IQR: 95-133cm), were included. Only one child achieved trough concentrations between 10µg/mL and 15µg/mL.Conclusion The empirical use of vancomycin in the children studied did not achieve the therapeutic pharmacokinetic/pharmacodynamic target for minimum inhibitory concentration of 1µg/mL.
Highlights
The therapeutic monitoring of antimicrobials is relevant and necessary to optimize pharmacotherapy and the selection of resistant bacteria, as well as to minimize the sub-therapeutic or toxic concentrations.[2,3,4,5,6] both safety and efficacy of antimicrobials related to the doses administered in children are questionable, since there are few studies conducted in this population on these therapeutic aspects.[2,4,5,7]
Children have not fully benefited from treatment and understanding of medication toxicity in the clinical progression of infection.[14,15] Recommendations for using vancomycin have undergone major changes over the years; yet, further studies are required to demonstrate evidence of efficacy of antimicrobial therapeutic monitoring in children.[14,16] The present study showed the empirical doses of vancomycin administered in children were unable to guarantee microbiological efficacy for both the Cmin and area under the curve (AUC)/minimum inhibitory concentration (MIC)
A recent review by Alves et al,(18) stated that in addition to dose individualization, the use of initial doses of vancomycin >60mg/kg/day is necessary to obtain effective concentrations of the drug.[2]. These findings reinforce the difficulty of establishing an empirical dose for children, and it is necessary to develop models that take into account the many characteristics of this population. These findings indicate the need for therapeutic monitoring of vancomycin, and should be a matter of concern regarding the use of antimicrobials in pediatric units, since the doses should be adjusted according to the profile of each child, to obtain an adequate therapeutic response.[2]
Summary
The determination of regimen of antimicrobials in children is supported by empirical protocols, based on the etiological knowledge einstein (São Paulo). 2019;17(1):1-7Alves GC, Chequer FM, Sanches C of infections, expert consensus, and linear reduction of adult doses.[1]Patients who are critically ill, including pediatric patients, present age-related physiological changes, with consequent pharmacokinetic (PK) instability to antimicrobials, and may present changes in the apparent volume of distribution (Vd), plasma clearance, and reduced biological half-life.[2,3]In addition, the therapeutic monitoring of antimicrobials is relevant and necessary to optimize pharmacotherapy and the selection of resistant bacteria, as well as to minimize the sub-therapeutic or toxic concentrations.[2,3,4,5,6] both safety and efficacy of antimicrobials related to the doses administered in children are questionable, since there are few studies conducted in this population on these therapeutic aspects.[2,4,5,7]. The determination of regimen of antimicrobials in children is supported by empirical protocols, based on the etiological knowledge einstein (São Paulo). The therapeutic monitoring of antimicrobials is relevant and necessary to optimize pharmacotherapy and the selection of resistant bacteria, as well as to minimize the sub-therapeutic or toxic concentrations.[2,3,4,5,6] both safety and efficacy of antimicrobials related to the doses administered in children are questionable, since there are few studies conducted in this population on these therapeutic aspects.[2,4,5,7]
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