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.


CONCLUSIONS
PK properties of all weight groups were similar. More frequent and higher doses are needed to achieve the goals of current guidelines.
Department of Pediatric Hematology Oncology, Meyer Children’s Hospital, Haifa, Israel.
Laila
L
Nassar
Salim
S
Hadad
Aharon
A
Gefen
Yael
Y
Shachor-Meyouhas
Tatiana
T
Mashiach
Norberto
N
Krivoy
Imad
I
Kassis
D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D019540:Area Under Curve; D001835:Body Weight; D002648:Child; D002675:Child, Preschool; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008826:Microbial Sensitivity Tests; D011446:Prospective Studies; D014640:Vancomycin / Q000008:administration & dosage* / Q000493:pharmacokinetics
D000900:Anti-Bacterial Agents; D014640:Vancomycin