Therapeutic monitoring of vancomycin according to initial dosing regimen in pediatric patients.
OBJECTIVE
This study aimed to determine the optimal initial vancomycin dose to achieve appropriate trough levels in pediatric patients.


METHODS
We analyzed clinical data for 309 children treated with intravenous vancomycin between 2004 and 2009 at 2 different hospitals in South Korea. The patients were 1-16 years old and exhibited normal renal function. Patient data, including reason for treatment and initial dosing regimen, were reviewed. Two subgroups were identified and compared according to initial vancomycin dose: 40 (35-45) mg/kg/day and 60 (55-65) mg/kg/day. Trough levels were obtained at steady state after at least 4 doses of vancomycin.


RESULTS
Patients who received vancomycin had post-operation or wound-related infections (37.2%), localized infection (12.9%), catheter-related infections (9.4%), meningitis (8.7%), or endocarditis (6.8%). Pathogens were confirmed in 79 cases: 28 cases of methicillin-resistant Staphylococcus epidermidis (35.4%) and 25 of methicillin-resistant Staphylococcus aureus (31.6%). Out of the 309 patients, 201 (65%) received vancomycin at 40 mg/kg/day and 108 (35%) at 60 mg/kg/day. Average trough concentrations were significantly different between the groups (P<0.001). Trough levels over 10 mg/L were less likely to be achieved in the 40 mg/kg/day group (14%) than in the 60 mg/kg/day group (49%) (P<0.001). There were no differences in renal function deterioration between the groups.


CONCLUSIONS
A common vancomycin dosing regimen, 40 mg/kg/day, was not high enough to achieve trough levels of over 10 mg/L in pediatric patients. Careful drug monitoring must be performed, and increasing initial dose of vancomycin should be considered in pediatric patients.
Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea.
Dae Il
DI
Kim
Mi Sun
MS
Im
Jin Hyoung
JH
Choi
Jina
J
Lee
Eun Hwa
EH
Choi
Hoan Jong
HJ
Lee
Am J Med. 2010 Feb;123(2):182.e1-7
20103028
Clin Pharmacokinet. 2004;43(13):925-42
15509186
J Antimicrob Chemother. 2000 Mar;45(3):329-35
10702552
Clin Infect Dis. 2005 Jun 15;40(12):1785-91
15909267
Clin Infect Dis. 2009 Oct 15;49(8):1169-74
19769538
Crit Care Clin. 2008 Apr;24(2):393-420, x-xi
18361953
Chest. 2006 Oct;130(4):947-55
17035423
J Trauma. 2009 Oct;67(4):802-4
19820588
Clin Infect Dis. 2008 Jun 1;46 Suppl 5:S360-7
18462091
Clin Infect Dis. 2006 Jan 1;42 Suppl 1:S5-12
16323120
Expert Opin Drug Saf. 2010 Jan;9(1):9-14
20021290
J Pharmacol Exp Ther. 1982 Jul;222(1):237-40
7086702
J Clin Microbiol. 2009 Jun;47(6):1640-4
19369444
J Crit Care. 2000 Mar;15(1):1-4
10757191
Clin Infect Dis. 2007 Sep 15;45 Suppl 3:S191-5
17712746
Am J Respir Crit Care Med. 2005 Feb 15;171(4):388-416
15699079
Arch Intern Med. 2006 Oct 23;166(19):2138-44
17060545
Clin Pharmacokinet. 2001;40(11):833-68
11735605
Clin Infect Dis. 2004 Feb 15;38(4):521-8
14765345
J Pediatr. 1980 Jan;96(1):119-26
7350291
Clin Infect Dis. 2004 Feb 1;38(3):448-51
14727222
J Antimicrob Chemother. 2006 Apr;57(4):699-704
16464892
Am J Health Syst Pharm. 2009 Jan 1;66(1):82-98
19106348
Pediatr Infect Dis J. 1995 Aug;14(8):667-73
8532423
Med Clin North Am. 1995 Jul;79(4):817-31
7791425
Mayo Clin Proc. 1977 Oct;52(10):631-4
909314
Pediatr Infect Dis J. 2009 May;28(5):398-402
19295465