title: Vancomycin serum concentrations in pediatric oncologic/hematologic intensive care patients.
abstract: BACKGROUND
  Usual treatment regimens with vancomycin often fail to provide adequate serum levels in patients with severe infections.
  
  
  METHODS
  Retrospective analysis of vancomycin trough serum measurements. The following parameters were calculated by Bayesian analysis: vancomycin clearance, distribution volume, and peak estimated concentrations. The area under the concentration curve (AUC) (total daily dose/24 h clearance of vancomycin) was used to determine the effectiveness of treatment through the ratio of AUC/minimum inhibitory concentration (MIC) above 400, using MIC=1 μg/mL, based on isolates of Staphylococci in cultures.
  
  
  RESULTS
  Sixty-one vancomycin trough measurements were analyzed in 31 patients. AUC/MIC>400 was obtained in 34 out of 61 dosages (55.7%), but the mean vancomycin dose required to achieve these levels was 81 mg/kg/day. In cases where the usual doses were administered (40-60 mg/kg/day), AUC/MIC>400 was obtained in nine out of 18 dosages (50%), in 13 patients. Trough serum concentrations above 15 mg/L presented a positive predictive value of 100% and a negative predictive value of 71% for AUC/MIC>400.
  
  
  CONCLUSIONS
  Higher than usual vancomycin doses may be required to treat staphylococcal infections in children with oncologic/hematologic diseases. Since the best known predictor of efficacy is the AUC/MIC ratio, serum trough concentrations must be analyzed in conjunction with MICs of prevalent Staphylococci and pharmacokinetic tools such as Bayesian analysis.
authors: Intensive Care Unit, Grupo de Apoio ao Adolescente e a Criança com Câncer, Instituto de Oncologia Pediátrica, Universidade Federal de São Paulo, Brazil.
authors: Dáfne Cardoso Bourguignon da
authors: DC
authors: Silva
authors: Gláucia Toribio Finoti
authors: GT
authors: Seixas
authors: Orlei Ribeiro de
authors: OR
authors: Araujo
authors: Rodrigo Genaro
authors: RG
authors: Arduini
authors: Fabianne Altruda de Moraes Costa
authors: FA
authors: Carlesse
authors: Antonio Sergio
authors: AS
authors: Petrilli
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000097:blood* / Q000493:pharmacokinetics; D019540:Area Under Curve; D001499:Bayes Theorem; D002648:Child; D002675:Child, Preschool; D003422:Critical Care; D054796:Drug Dosage Calculations; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008826:Microbial Sensitivity Tests; D009369:Neoplasms / Q000821:virology*; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000188:drug therapy*; D013210:Staphylococcus / Q000187:drug effects*; D014640:Vancomycin / Q000008:administration & dosage / Q000097:blood* / Q000493:pharmacokinetics
chemical_list: D000900:Anti-Bacterial Agents; D014640:Vancomycin