Abstract
Vancomycin is commonly used as a treatment for neonatal infections. However, there is a lack of consensus establishing the optimal vancomycin therapeutic regimen and defining the most appropriate PK/PD parameter correlated with the efficacy. A recent guideline recommends AUC–guided therapeutic dosing in treating serious infections in neonates. However, in clinical practice, trough serum concentrations are commonly used as a surrogate PKPD index for AUC24. Despite this, target serum concentrations in a neonatal population remain poorly defined. The objective is to describe the relationship between therapeutic regimens and the achievement of clinical or pharmacokinetic outcomes in the neonatal population. The review was carried out following PRISMA guidelines. A bibliographic search was manually performed for studies published on PubMed and EMBASE. Clinical efficacy and/or target attainment and the safety of vancomycin treatment were evaluated through obtaining serum concentrations. A total of 476 articles were identified, of which 20 met the inclusion criteria. All of them evaluated the target attainment, but only two assessed the clinical efficacy. The enormous variability concerning target serum concentrations is noteworthy, which translates into a difficulty in determining which therapeutic regimen achieves the best results. Moreover, there are few studies that analyze clinical efficacy results obtained after reaching predefined trough serum concentrations, this information being essential for clinical practice.
Highlights
Vancomycin is a glycopeptide antibiotic commonly used for the treatment of neonatal infections caused by coagulase–negative staphylococci (CoNS), methicillin–resistant Staphylococcus aureus (MRSA) and enterococci species [1,2]
Even though vancomycin is widely used in neonates, there is a lack of consensus establishing the optimal vancomycin therapeutic regimen [2], due to its high pharmacokinetic (PK) variability and greater interindividual variability than in the adult population [3]
Two of the articles included in this review evaluated the clinical efficacy of the vancomycin treatment [29,30]
Summary
Vancomycin is a glycopeptide antibiotic commonly used for the treatment of neonatal infections caused by coagulase–negative staphylococci (CoNS), methicillin–resistant Staphylococcus aureus (MRSA) and enterococci species [1,2]. Even though vancomycin is widely used in neonates, there is a lack of consensus establishing the optimal vancomycin therapeutic regimen [2], due to its high pharmacokinetic (PK) variability and greater interindividual variability than in the adult population [3]. The neonatal population is characterized by a higher body water percentage, reduced protein binding and higher free fraction [4] and decreased renal clearance at birth, which gradually increases as the renal system matures [5]. This fact must be taken into consideration, since vancomycin can cause nephrotoxicity, because renal is the primary route of excretion. Therapeutic drug monitoring (TDM) takes on a fundamental role in these patients
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