Vancomycin In Children Research Articles

Vancomycin Infusion Methods on Phlebitis Prevention in Children.

Background:Hospitalized children require antibiotic therapy. The most common side effect of intravenous injections is Phlebitis. Due to high usage of Vancomycin in children and subsequent phlebitis in their intravenous lines, the current study aimed at comparing the effects of two intervention and routine vancomycin infusion methods in preventing phlebitis in hospitalized children.Materials and Methods:The current study is a quasi-experimental study investigating 74 individuals between ages of 1 month and 6 years undergoing treatment using vancomycin. First, 37 children, hospitalized in internal medicine ward of Isfahan Paediatrics' Hospital, Iran with vancomycin infusion orders, were placed in control group, and another 37 children were placed in the intervention group through matching with control group. The intervention group used phlebitis prevention guidelines, created by the authors, while control group used routine infusion method of the hospital. Data were analyzed by SPSS software, and statistical significance was set at 5%.Results:The occurrence of phlebitis was 45.90% in intervention and 89.10% in control group. Results showed that the frequency of phlebitis in intervention group was significantly lower than control group (χ2= 15.79, df = 1, p < 0.001) and the average time of phlebitis onset in control group was also significantly lower than that of the intervention group (t72= 2.99, p = 0.004).Conclusions:According to the results, intervention vancomycin infusion method is more effective in reducing phlebitis as a result of intravenous catheter, compared to the routine vancomycin infusion method.

Distribution characteristics of plasma concentration of vancomycin and clinical efficacy in pediatric patients with severe pneumonia and congenital heart disease

Objective To analyze the distribution characteristics of vancomycin blood concentration in children with severe pneumonia complicated with congenital heart disease(CHD) and children with simple severe pneumonia after using the same dose vancomycin, and observe the clinical efficacy at the same time. Methods Plasma concentrations in pediatric patients with severe pneumonia complicated with CHD(CHD group) who treated by vancomycin from November 2012 to September 2013 in Shengjing Hospital of China Medical University were collected.Plasma concentrations of children with simple severe pneumonia(control group) treated by vancomycin were also collected at the same period.The blood concentration values and therapeutic effects of the two groups were recorded into the database for statistical analysis.Peak, trough concentrations and efficacy were analyzed by receiver operating characteristic(ROC) curve. Results Twenty-five children with CHD were collected, the average peak concentration was (28.39±6.68)mg/L, the average trough concentration was (13.34±6.62)mg/L.Control group were also 25 cases, the average peak concentration was (16.23±2.50)mg/L and the average trough concentration was (2.77±1.01)mg/L.Both peak and trough concentrations of CHD children were significantly higher than those of the control group (tpeak=8.52, Ppeak<0.05; ttrough=7.89, Ptrough<0.05). In the ROC of peak, trough concentrations and efficacy, area under the curve were 0.74(95%CI 0.547-0.935, P=0.01) and 0.77(95%CI 0.605-0.935, P=0.004) respectively, and the difference was statistically significant. Conclusion Plasma concentrations of vancomycin in children with CHD are generally higher, it is necessery to monitor plasma concentration even under regular doses, to make the application of vancomycin more safe and effective in children with CHD.There is a correlation between plasma concentration of vancomycin and clinical efficacy in children, the higher the blood concentration, the more likely the clinical efficacy is to be effective. Key words: Severe pneumonia; Congenital heart disease; Vancomycin; Serum concentration; Peak concentration; Trough concentration

Application of oral Vancomycin in children with primary sclerosing cholangitis

The role and potential function of oral vancomycin in regulating intestinal microflora and prospect of alleviating function of vancomycin in primary sclerosing cholangitis were reviewed, based on domestic and abroad clinical researches and experiments.Through this review, it can provide new ideas for clinical treatment of primary sclerosing cholangitis and to fill vacancies in oral administration of vancomycin in domestic: oral vancomycin play a consi-derable role in the improvement of clinical indicators and clinical manifestations of the primary sclerosing cholangitis patients, affecting the immune response and the release of related cytokines.Based on this, it has the potential to play a role in alleviating the disease in children with primary sclerosing cholangitis.In addition, through the problems remain resolved in this review, we provides a new research direction for future clinical research. Key words: Vancomycin; Oral preparations; Hepatobiliary disease; Primary sclerosing cholangitis

A retrospective study to estimate serum vancomycin trough concentrations in pediatric patients with current recommended dosing regimen

Background: Vancomycin is widely prescribed to treat infections caused by methicillin-resistant Staphylococcus aureus (MRSA). According to the Infectious Disease Society of America 2011 MRSA guidelines for adults, trough concentrations of 15–20 μg/ml were recommended with vancomycin 15–20 mg/kg/dose every 8–12 h not to exceed 2 g per dose in patients with normal renal function. As the data for dosage and monitoring of vancomycin in children are still controversial, physicians often follow the guidelines established for adults. To evaluate serum vancomycin trough concentrations in pediatric patients with currently recommended dosing regimen, we evaluated clinical data. Methods: This retrospective observational study collected pediatric patients aged <18 years for whom vancomycin was administered at a single medical center between 2009 and 2015. Results: Fifty pediatric patients were analyzed. Two groups were identified according to the vancomycin dosage. Fourteen (28%) patients underwent vancomycin at 60 mg/kg/day (high dose) and 36 (72%) patients at 40 mg/kg/day (low dose). The average serum vancomycin trough concentrations of the two groups were 13.12 μg/ml (high-dose group) and 9.02 μg/ml (low dose group), respectively. In addition, 71% (high-dose group) and 91% (low-dose group) of patients could not reach the target trough concentrations 15–20 μg/ml, set by the Infectious Disease Society of America. Conclusion: This investigation revealed that the current recommended vancomycin dosing regimens in children (40–60 mg/kg/day) mostly brought out trough concentrations <10 μg/ml in this research population.

Vancomycin (VAN) administered as continuous infusion (CIV) vs. intermittent infusion (IIV) in children with Methicillin-Resistant Staphylococcus aureus (MRSA) infections

Abstract Background Guidelines for treatment of MRSA infections recommend VAN trough (TR) of 15–20 mg/L to achieve a 24-hour ratio of area-under-the-curve (AUC24) over minimum inhibitory concentration (MIC) ≥ 400, the primary pharmacodynamic (PD) parameter that predicts VAN efficacy. However, achieving this target TR in children is difficult in clinical settings and may not be necessary to achieve AUC24/MIC ≥ 400. Additionally, higher doses and TR &amp;gt;15 mg/L have been associated with increased risk for VAN nephrotoxicity. The use of CIV may lead to lower VAN exposure and subsequent toxicity while achieving the desired AUC24/MIC ratio. To our knowledge there are no reports exploring differences in VAN exposure, AUC24/MIC ratio and toxicity between CIV and IIV VAN in children. Methods We conducted a retrospective, cohort study between January 1, 2011–December 30, 2016. Children ages 3 months–18 years with an MRSA infection were included. Only the highest VAN level and total daily dose (TDD) within the first 72 hours of treatment were included for analysis. Patients with CrCl &amp;lt; 30 mL/minute/1.73m2 were excluded. Primary outcome was differences in TDD, AUC24 and AUC24/MIC. Secondary outcomes evaluated adverse events. Results Twenty-two patients were evaluated, 11 received IIV and 11 received CIV VAN. Median age, weight, gender, baseline serum creatinine, VAN clearance and volume of distribution were similar in both groups. Fewer patients in the IIV group received concomitant nephrotoxic drugs compared with CIV group (5/11 (45%) vs.. 10/11 (91%), P = 0.03). Patients in the IIV group received more VAN (median 85 mg/kg/day vs. 67 mg/kg/day, P = 0.08) and had higher AUC24 (723 mg*hours/L, (IQR 669–752) vs. 572 mg*hours/L, (IQR 459–633), P = 0.02) compared with CIV. Patients in IIV group had lower median TR (16 mg/L vs. 25 mg/L) that required longer time to attain (50.9 hours, (IQR 42–70) vs. 21.5 hours (IQR 17–34), P = 0.04) than serum levels in CIV. Both groups had a median VAN MIC 1 mg/L with a trend towards higher AUC24/MIC observed in IIV group (752 vs. 621, P = 0.07). More patients in IIV group experienced VAN-related adverse events (renal toxicity, infusion reactions, phlebitis) compared with CIV (7/11 (64%) vs. 1/11 (9%), P = 0.01). Conclusion In pediatric patients, CIV VAN achieved the recommended PD target in shorter time, and with fewer adverse events compared with IIV. Disclosures All authors: No reported disclosures.

Evaluation of early achievement of an AUC/MIC of &amp;gt;400 for Vancomycin in children with methicillin-resistant Staphylococcus aureus bacteremia

Abstract Background Methicillin-resistant Staphylococcus aureus (MRSA) bacteremia causes morbidity and mortality in children. The standard treatment for MRSA bacteremia is vancomycin, which should achieve a 24 hour area under the curve over the minimum inhibitory concentration ratio (AUC/ MIC) of &amp;gt;400. Whether or not attaining AUC/ MIC &amp;gt;400 early in the disease course improves outcomes in children is controversial. The aim of our study was to determine whether early achievement of AUC/ MIC &amp;gt;400 improved outcomes in children with MRSA bacteremia. Methods Children whose blood culture grew MRSA between March 2010 and April 2017 at Tokyo Metropolitan Children’s Medical Center were enrolled. The exclusion criteria were no vancomycin administration, use of extracorporeal membrane oxygenation, no data on dosage and vancomycin MIC, and cases of contamination. Susceptibility testing was performed by a microdilution method. The outcomes of patients who achieved an AUC/MIC &amp;gt;400 at the first assessment prior to the Fourth or Fifth vancomycin dose were compared with those of patients who did not. The clinical outcomes were persistent bacteremia on Days 3 and 7, mortality at 30 days, and the recurrence of MRSA bacteremia. Results In total 175 MRSA isolates from 50 children were identified. Of these 56 episodes were eligible for enrollment. Forty-one subjects (73.2%) were boys. The median age was 9 months (interquartile range: 1.8–120.5 months). The median initial dose of vancomycin was 40 mg/kg (interquartile range: 30–44.3 mg/kg). Among MRSA isolates, vancomycin MIC of &amp;lt; 0.5 mcg/mL, 1 mcg/mL and 2 mcg/mL were 1 (1.8%), 53 (94.6%) and 2 (3.6%), respectively. Fifteen patients (26.8%) achieved AUC/MIC &amp;gt;400 early. The two groups did not differ significantly in terms of persistent bacteremia on Days 3 (P = 0.96) or 7 (P = 0.82), mortality at 30 days (P = 0.47), or the recurrence of MRSA bacteremia (P = 1.0). Conclusion Children with bacteremia who achieved AUC/ MIC&amp;gt;400 early did not differ significantly from children who did not in terms of their clinical outcomes. Disclosures All authors: No reported disclosures.

Impact of Initial Vancomycin Trough Concentration on Clinical and Microbiological Outcomes of Methicillin-Resistant Staphylococcus aureus Bacteremia in Children.

It is important to use vancomycin in a proper manner to ensure optimal drug exposure. Despite extensive use of vancomycin in children, studies on its optimal trough concentration (Ctrough) in the pediatric population remained rare. This retrospective study included children < 18 years old with culture-confirmed methicillin-resistant Staphylococcus aureus (MRSA) bacteremia who were hospitalized in our institute from January 2010 to April 2014. Clinical characteristics, initial vancomycin dose, Ctrough and clinical/microbiological outcomes were retrospectively collected from medical records. Forty-six MRSA bacteremia cases occurring to the patients with a mean age of 22.0 ± 46.9 months were included and all of them were healthcare-associated. Severe diseases requiring intensive care unit (ICU) stay, mechanical ventilation and/or resulting in death were observed in 57.8% (26/45); all-cause 30-day fatality was 11.1% (5/45). An initial Ctrough ≥ 15 μg/mL was achieved in only 4 (8.7%) cases with an average vancomycin dosage of 40.6 ± 7.9 mg/kg/day. Persistent bacteremia at 48 hours after initiation of vancomycin was observed more frequently in children with initial Ctrough < 10 μg/mL than in those with Ctrough ≥ 10 μg/mL (P = 0.032). However, there was no statistically significant difference between the two groups in terms of 30-day mortality and recurrent bacteremia (P = 0.899, and P = 0.754, respectively). Although initial Ctrough may be a useful parameter for minimizing early microbiological failure, it does not predict 30-day fatality or recurrence in pediatric MRSA bacteremia. Further prospective data on vancomycin dosing are needed to find the optimal drug exposure and clarify its impact on clinical outcomes in pediatric populations.

Continuous Infusion of Vancomycin in Children with Invasive Methicillin-Resistant Staphylococcus aureus Infections

Continuous Infusion of Vancomycin in Children with Invasive Methicillin-Resistant Staphylococcus aureus Infections

A Prospective Pilot Study on the Systemic Absorption of Oral Vancomycin in Children With Colitis.

BACKGROUND: Oral vancomycin is used to treat refractory colitis due to Clostridium dificile infection. Traditionally, oral vancomycin was thought to not be absorbed systemically, but recent adult studies have demonstrated detectable serum levels in over half of patients with severe colitis. This has not been studied in children. OBJECTIVE: To determine the absorption of oral vancomycin and the renal safety profile of oral vancomycin in children hospitalized with colitis. METHODS: We performed a prospective, observational, pilot proof of principle study at the North Carolina Children's Hospital in patients 2 years to 18 years of age receiving oral vancomycin for the treatment of C dificile colitis. Severity of disease was determined using a validated scoring system. Serial serum vancomycin levels and renal function tests were performed during the administration of oral vancomycin. RESULTS: All patients enrolled (n = 8) had mild to moderate C dificile colitis and varying severity of underlying systemic diseases; 7 with inflammatory bowel disease and 1 with acute kidney injury following renal transplantation. No enrolled patients had detectable levels of serum vancomycin. Additionally, no adverse renal outcomes were attributed to oral vancomycin, and no cases of "Red Man" syndrome were observed. CONCLUSIONS: Unlike studies in adult patients, oral vancomycin is likely not absorbed in children with mild to moderate colitis. Further study is needed to determine the pharmacokinetics in severe colitis and those with severe illness in a critical care setting.

A reference for clinical practice of vancomycin according to pharmacokinetic modeling based on plasma concentration monitoring in children

Objective To investigate the trough and peak vancomycin plasma concentrations in steady-state following regular dosage and to improve dosing regimen based on pharmacokinetic modeling, providing reference for clinical practice in children. Methods We retrospectively analyzed pharmacokinetics of vancomycin in 50 cases admitted in our PICU who had been confirmed or suspected with gram-positive bacterial infections following regular dosage[40 mg/(kg·d)]. Then we tried to optimize dosing regimens with Monte Carlo simulation to evaluate different dosing regimens of vancomycin in children. Results With regular dosage of vancomycin, mean trough concentrations of vancomycin were (11.02±4.44) mg/L, trough concentrations higher than 15 mg/L accounted for only 12%.In the actual program, the extension of a single intravenous infusion to 3 hours after administration would result in 26% of trough concentrations distributing in the range above 15 mg/L.If we increased daily dose to 50 mg/kg and 60 mg/kg with simulation, the trough concentration distribution frequency above 15 mg/L would increase from 12% to 32% and 40%.If minimum inhibitory concentration of vancomycin to pathogenic bacteria(Staphylococcus aureus) was 1 mg/L, the probabilities of target attainment for pharmacokinetic/pharmacodynamic evaluation were 51.73%, 76.54% and 87.5% for three dosages[40 mg/(kg·d), 50 mg/(kg·d) and 60 mg/(kg·d)] of vancomycin, respectively.We suspected that dosage of 60 mg/(kg·d) was a good choice.With this dosage regimen, we could achieve a substantial increase in the probability of target attainment. Conclusion Following regular dosages, trough concentration distribution frequency from 15 to 20 mg/kg is low.The extension of a single intravenous infusion time can not achieve a good result.According to the result of pathogenic bacteria and antimicrobial susceptibility tests, increasing daily dosage of vancomycin to 60 mg/(kg·d) will help to improve the trough concentration and get more clinic achievements. Key words: Vancomycin; Plasma concentration; Pharmacokinetics; Children

Vancomycin monitoring in children using bayesian estimation.

Optimal monitoring of vancomycin in children needs evaluation using the exposure target with area under the curve (AUC) of the serum concentrations versus time over 24 hours. Our study objectives were to: (1) compare the accuracy and precision of vancomycin AUC estimations using 2 sampling strategies-1 serum concentration sample (1S, near trough) versus 2 samples (2S, near peak and trough) against the rich sample (RS) method; and (2) determine the performance of these strategies in predicting future AUC against an internal validation sample (VS). This was a retrospective cohort study using population-based pharmacokinetic modeling with Bayesian post hoc individual estimations in nonlinear mixed effects modeling (version 7.2). Pediatric subjects 3 months-21 years of age who received vancomycin ≥48 hours and had more than 3 drug samples within the first ≤96 hours of therapy were enrolled. Outcome measures were the accuracy, precision, and internal predictive performance of AUC estimations using 2 monitoring strategies (ie, 1S versus 2S) against the RS (which was derived from modeling all serum vancomycin concentrations obtained anytime during therapy) and VS (from serum concentrations obtained after 96 hours of therapy). Analysis included 138 subjects with 712 vancomycin serum concentrations. Median age was 6.1 (interquartile range, 2.2-12.2) years, weight 22 (13-38) kg, and baseline serum creatinine 0.37 (0.30-0.50) mg/dL. Both accuracy and precision were improved with the 2S, compared with 1S, for AUC estimations (-2.0% versus -7.6% and 10.3% versus 12.8%, respectively) against the RS. Improved accuracy and precision were also observed for 2S when evaluated against VS in predicting future AUC. Compared with 1S, the 2S sampling strategy for vancomycin monitoring improved accuracy and precision in estimating and predicting future AUC. Evaluating 2 drug concentrations in children may be prudent to ensure adequate drug exposure.

Population Pharmacokinetics and Dosing Optimization of Vancomycin in Children with Malignant Hematological Disease

An increase in vancomycin dose has been proposed in adults with malignant hematological disease. As pediatric data are limited, our aim was to evaluate the population pharmacokinetics of vancomycin in order to define the appropriate dosing regimen in children with malignant hematological disease. Vancomycin concentrations were collected prospectively during therapeutic monitoring. Population pharmacokinetic analysis was performed using NONMEM software. Seventy children (age range, 0.3 to 17.7 years) were included. With the current recommended dosing regimen of 40 to 60 mg/kg/day, 53 children (76%) had subtherapeutic steady-state trough concentrations (Css/min of <10 mg/liter). A one-compartment model with first-order elimination was developed. Systematic covariate analysis identified that weight significantly influenced clearance (CL) and volume of distribution (V) with power functions of 0.677 for CL and 0.838 for V. Vancomycin CL also significantly increased with increases in creatinine clearance and seemed to be higher in children with malignant hematological disease than in the general pediatric population. The model was validated internally. Its predictive performance was further confirmed in an external validation by Bayesian estimation. A patient-tailored dosing regimen was developed based on the final pharmacokinetic model and showed that a higher proportion of patients reached the target Css/min than with the traditional mg/kg-basis dose (60% versus 49%) and that the risks associated with underdosing or overdosing were reduced. This is the first population pharmacokinetic study of vancomycin in children with malignant hematological disease. An optimized dosing regimen, taking into account patient weight, creatinine clearance, and susceptibility of the pathogens involved, could routinely be used to individualize vancomycin therapy in this vulnerable population.

Farmacocinética de vancomicina en niños hospitalizados en una unidad de paciente crítico

Monitoring PK/PD of vancomycin with basal and peak serum levels and the area under the curve of drug exposure 24 h/MIC (ABC 24 h/MIC) could optimize the management of children. To study the PK of vancomycin in children hospitalized in the Pediatric Intensive Care Unit (PICU), assessing PK/PD parameters withABC24 h/MIC. Retrospective, descriptive study in the PICU (Hospital Luis Calvo Mackenna) between January 2008-March 2010. We included children < 18 years who required antimicrobial treatment with vancomycin for suspected/confirmed staphylococcal infection using a dose of 40 mg/k/day. Plasmatic levels were performed one hour postinfusion and 30 min prior to the next dose. The following PK/PD parameters were calculated: vancomycin clearance, elimination rate constant, volume of distribution, half-life (T1/2) and ABC 24 h/ MIC. We enrolled eighty-four children. According to ABC 24 h/MIC obtained, 54% (45/84) of children reached an optimal level (> 400 mg*hr/L). Based on the traditional PK/PD parameters, 49% of cases (41/84) presented a basal level of vancomycin in the therapeutic range (5-15 μg/mL) and of those, only 39% (16/41) had a ABC 24 h/MIC over 400 mg*h/L. Based on our results, children admitted to PICU could be exposed to sub therapeutic doses of vancomycin. We recommend to implement tailored antimicrobial treatment monitoring vancomycin PK/PD parameters.

A Randomized Controlled Trial of a Vancomycin Loading Dose in Children

Despite its frequent use, the optimal dosing regimen of intravenous vancomycin remains controversial. Achievement of therapeutic trough early in the course of illness may be beneficial. Our objective was to assess whether a loading dose of vancomycin would increase the proportion of children reaching target trough concentrations 8 hours after initiation of therapy. We enrolled hospitalized children aged 2-18 years prescribed vancomycin at Boston Children's Hospital between February 2011 and January 2012. Participants were randomized to receive a loading dose (30 mg/kg) or a conventional initial dose (20 mg/kg). These were followed by a 20 mg/kg/dose every 8 hours in both groups. Serum vancomycin concentrations were measured before the second and third doses. Pharmacokinetic parameters were calculated using individual and population pharmacokinetic models. Two of nineteen (11%) loading dose recipients had a trough 15-20 mg/L before the second dose, compared with 0 of 27 in the conventional dose group (P=0.17). However, the median area under the curve/minimum inhibitory concentration estimates (for a hypothetical minimum inhibitory concentration=1 mg/L) were above 400 in both groups. Red man syndrome incidence was higher in loading dose recipients (48% vs. 24%, P=0.06). A vancomycin loading dose did not result in earlier achievement of therapeutic trough concentrations in this study. However, the systemic exposure to vancomycin in children administered 60 mg/kg/day was adequate, despite lower than recommended measured trough levels. Therefore, the need for higher target trough concentrations should be questioned.

Erythroderma caused by vancomycin in children: concentration and speed of infusion

Vancomycin is an antibiotic glycopeptide that was isolated of the Streptomyces orientalis. It was introduced in the clinical practice for treatment of infections caused by staphylococcus in which other antibiotics were proving to be ineffective. In this retrospective study, we determine its prescription, clinical characteristics as well as the factors that favor the apparition of the erythroderma or red-man syndrome in a paediatric hospital. Forty patients to which physicians administer vancomycin and presented erythroderma were evaluated. Male gender was more predominated, with a total of 25 cases (62.5 %). The average age was of 12 ± 6 years. We identified two main factors that are directly related to the appearance of erythroderma. On one hand, the "concentration of the drug", which is related to the dilution that it is realized when a dose of vancomycin is going to be administered to the patient and on the other hand the “time or speed of infusion”. In the present study, it was found a low incident of this adverse reaction and few cases of complications.

Population Pharmacokinetics of Intermittent Vancomycin in Children with Cystic Fibrosis

Vancomycin is the drug-of-choice for the treatment of methicillin-resistant Staphylococcus aureus (MRSA) infections in children with cystic fibrosis. However, no studies have characterized the pharmacokinetic profile of vancomycin among pediatric cystic fibrosis patients. To evaluate the pharmacokinetics of intermittent vancomycin administration in children with cystic fibrosis and identify covariates that significantly influence vancomycin efficacy and safety. Therapeutic drug monitoring data were obtained from two cystic fibrosis care centers that identified children <18years who received vancomycin treatment for an acute pulmonary exacerbation from 2005 to 2010. Trough and peak serum concentrations were determined before and after the third or fourth dose. Nonlinear mixed effects models were developed to evaluate the population pharmacokinetics of vancomycin. Among the 67 children (mean age 12.1±5.3years), the mean vancomycin dose was 17.4±4.4mg/kg. The mean trough concentration (Cmin ) was 10.3±3.8mg/L. The mean daily area under the serum concentration time curve (AUC24 ) was 282.5±816.9mg·hour/L. A one-compartment model with first-order elimination best described the data. Weight significantly influenced vancomycin clearance (p<0.001). In the final model, clearance was estimated as 5.57L/hour/70kg, and the volume of distribution was 44.1L/70kg. The between subject variability for clearance and volume of distribution were 27% and 40%, respectively. Using a one-compartment model to evaluate the pharmacokinetic properties of vancomycin in children with cystic fibrosis, clearance increased with body weight. Pharmacodynamic studies are needed to establish an optimal vancomycin dosing regimen for the treatment of pediatric exacerbations of cystic fibrosis.

Prospective Evaluation of the Dosing Regimen of Vancomycin in Children of Different Weight Categories

Background: Pharmacokinetics (PK), pharmacodynamics and optimal dosing of vancomycin in obese children is not known. Higher trough levels of vancomycin may improve outcomes. This prospective study evaluated the appropriateness of twice-daily regimen for the adherence to guidelines, among obese and non obese children. Methods: Children receiving vancomycin, (20 mg/kg BID) were included. Patients were divided into 3 groups. Adequacy was defined as trough level ≥ 10mg/L and AUC/MIC > 400. An alternative-dosing regimen was calculated based on individual PK parameters. Results: Seventy-seven pairs (trough, peak) were taken from 51 children. Mean trough level was 3.36±2.58, only 3% fell in therapeutic range, no statistical difference was observed between obese, normal weight or underweight groups. One child had an AUC/MIC > 400. All children recovered. Conclusion: PK properties of all weight groups were similar. More frequent and higher doses are needed to achieve the goals of current guidelines.

Prospective Evaluation of the Dosing Regimen of Vancomycin in Children of Different Weight Categories

Pharmacokinetics (PK), pharmacodynamics and optimal dosing of vancomycin in obese children is not known. Higher trough levels of vancomycin may improve outcomes. This prospective study evaluated the appropriateness of twice-daily regimen for the adherence to guidelines, among obese and non obese children. Children receiving vancomycin, (20 mg/kg BID) were included. Patients were divided into 3 groups. Adequacy was defined as trough level ≥ 10mg/L and AUC/MIC > 400. An alternative-dosing regimen was calculated based on individual PK parameters. Seventy-seven pairs (trough, peak) were taken from 51 children. Mean trough level was 3.36 ± 2.58, only 3% fell in therapeutic range, no statistical difference was observed between obese, normal weight or underweight groups. One child had an AUC/MIC > 400. All children recovered. PK properties of all weight groups were similar. More frequent and higher doses are needed to achieve the goals of current guidelines.

Continuous versus intermittent vancomycin in children after cardiac surgery with delayed sternal closure

Delayed sternal closure (DSC) is a technique used in patients with hemodynamic instability, lung dysfunction, edema or prolonged bleeding after cardiac surgery. This group of patients has significant morbidity and mortality with fluid overload and changes in renal function. Adequate antibiotic coverage is of great importance and vancomycin is used as a part of antibiotic prophylaxis in our department. The objective of our study was to compare the efficacy and efficiency of intermittent and continuous vancomycin in pediatric cardiac patients with DSC.

Continuous versus intermittent vancomycin in children after cardiac surgery with delayed sternal closure

Delayed sternal closure (DSC) is a technique used in patients with hemodynamic instability, lung dysfunction, edema or prolonged bleeding after cardiac surgery. This group of patients has significant morbidity and mortality with fluid overload and changes in renal function. Adequate antibiotic coverage is of great importance and vancomycin is used as a part of antibiotic prophylaxis in our department. The objective of our study was to compare the efficacy and efficiency of intermittent and continuous vancomycin in pediatric cardiac patients with DSC.