title: Evaluation of a pediatric continuous-infusion vancomycin therapy guideline.
abstract: OBJECTIVE
  An institutional guideline for converting pediatric patients to continuous-infusion vancomycin (CIV) therapy if therapeutic targets are not achieved with intermittent i.v. dosing was evaluated.
  
  
  METHODS
  All patients within a specified age range (>6 months but <19 years) who were converted to CIV therapy for pneumonia or osteomyelitis during the 2 years after guideline implementation were included in the evaluation. The guideline calls for conversion to CIV therapy if goals for trough serum vancomycin concentration (SVC) are not attained with escalating intermittent-infusion vancomycin (IIV) dosing. Primary outcome measures included the rate of attainment of the goal steady-state trough SVC (15-20 mg/L), preferably within 24-48 hours, the adequacy of an empirical dosing strategy, and adverse events. Secondary study outcomes included final vancomycin doses and the time to attainment of therapeutic SVCs.
  
  
  RESULTS
  Within 24-48 hours after conversion to CIV therapy, the mean initial plateau SVC in the evaluated cases (n = 15) was 20.2 mg/L; the mean of all SVCs was 19.1 mg/L. The range of dosages required to achieve a plateau SVC of 15 mg/L was 23.8-65.4 mg/kg/day (median, 41 mg/kg/day). The mean ± S.D. vancomycin dosage at the end of CIV therapy was 44.3 ± 12.8 mg/kg/day. Monitoring of serum creatinine, urine output, and glomerular filtration rate indicated that no patients developed nephrotoxicity during CIV therapy.
  
  
  CONCLUSIONS
  Conversion from IIV to CIV therapy in selected pediatric patients appeared to be safe and well tolerated, with few adverse effects noted. Using the institutional CIV dosing guideline, goal plateau SVC values were attained in most patients within 24-48 hours.
authors.affiliation: Department of Clinical Pharmacy, School of Pharmacy, University of California, San Francisco, USA. smckamy@memorialcare.org
authors.forename: Susan
authors.initials: S
authors.lastname: McKamy
authors.forename: Tempe
authors.initials: T
authors.lastname: Chen
authors.forename: Michelle
authors.initials: M
authors.lastname: Lee
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Ambrose
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000493:pharmacokinetics; D002648:Child; D002675:Child, Preschool; D005260:Female; D017408:Guidelines as Topic; D006801:Humans; D007223:Infant; D007262:Infusions, Intravenous / Q000592:standards*; D008297:Male; D010019:Osteomyelitis / Q000097:blood / Q000188:drug therapy*; D011014:Pneumonia / Q000097:blood / Q000188:drug therapy*; D014640:Vancomycin / Q000008:administration & dosage* / Q000009:adverse effects / Q000493:pharmacokinetics*
chemical_list: D000900:Anti-Bacterial Agents; D014640:Vancomycin