A prospective study of vancomycin pharmacokinetics and dosage requirements in pediatric cancer patients.
Pharmacokinetics of vancomycin and dosage requirements were evaluated prospectively in 28 pediatric cancer patients 9 months to 13 years of age. The predictive performance of a two-compartment Bayesian forecasting program was also evaluated. A mean (+/- SD) daily dosage of 75 +/- 22 mg/kg/day was necessary to attain a mean peak serum vancomycin concentration (SVC) of 23.1 +/- 5.8 mg/liter and a mean trough SVC of 6.2 +/- 2.3 mg/liter. Mean vancomycin clearance, volume of distribution and serum half-life were 0.153 +/- 0.033 liter/hour/kg, 0.63 +/- 0.08 liter/kg and 2.95 +/- 0.48 hours. Final peak SVCs, which reflected the last dosage regimens received, were predicted with minimal bias (mean prediction error, -1.2 mg/liter) and accurate precision (root mean-squared prediction error, 2.0 mg/liter) whereas trough SVCs were predicted with even smaller bias (mean prediction error, -0.1 mg/liter) and greater precision (root mean-squared prediction error, 0.8 mg/liter). This study showed that pediatric cancer patients with normal renal function required vancomycin dosage regimens substantially greater than the standard 40 mg/kg/day to attain the desired SVCs.
Division of Pharmacy, Childrens Hospital Los Angeles, CA 90027.
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D
Chang
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L
Liem
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M
Malogolowkin
D000293:Adolescent; D001499:Bayes Theorem; D002648:Child; D002675:Child, Preschool; D006801:Humans; D007223:Infant; D009369:Neoplasms / Q000188:drug therapy*; D011446:Prospective Studies; D014640:Vancomycin / Q000008:administration & dosage* / Q000493:pharmacokinetics*
D014640:Vancomycin