Optimization of vancomycin dosing in very low-birth-weight preterm neonates.
OBJECTIVE
To compare vancomycin serum trough concentrations and 24-hour area under the serum concentration-versus-time curve (AUC24) among very low-birth-weight (VLBW) premature infants before and after implementation of an institution-wide increase in neonatal vancomycin dosing.


METHODS
We performed a retrospective analysis of vancomycin concentrations among preterm VLBW neonates before (2007-2010) and after (2010-2013) implementation of a new vancomycin dosing protocol consisting of increased vancomycin daily dose and frequency of administration.


RESULTS
Neonates weighing < 1,500 g and receiving the new vancomycin dosing regimen had lower rates of undetectable trough concentrations (24 vs. 50%, p = 0.04), higher median trough concentrations (10.8 vs. 5.9 µg/mL, p = 0.003), a higher proportion of goal trough concentrations of 10 to 20 µg/mL (35 vs. 4%, p = 0.005), and a significantly higher vancomycin AUC24 (438 vs. 320 mg·h/L, p = 0.004) compared with historical controls.


CONCLUSIONS
Increasing the vancomycin daily dose and dosing frequency led to an increase in vancomycin trough concentrations and AUC24, and a decrease in the proportion of undetectable (< 5.0 µg/mL) troughs, without an increase in toxicity among VLBW premature neonates.
Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota.
Theresa
T
Madigan
Division of Pediatric Infectious Diseases, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota.
Christine B
CB
Teng
Department of Pharmacy, All Children's Hospital, St. Petersburg, Florida.
Jena
J
Koshaish
Pharmacy Services, Mayo Clinic, Rochester, Minnesota.
Kent R
KR
Johnson
Pharmacy Services, Mayo Clinic, Rochester, Minnesota.
Kevin K
KK
Graner
Division of Pediatric Infectious Diseases, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota.
Ritu
R
Banerjee
D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000493:pharmacokinetics; D016470:Bacteremia / Q000188:drug therapy*; D015331:Cohort Studies; D020345:Enterocolitis, Necrotizing / Q000188:drug therapy*; D005260:Female; D006801:Humans; D062071:Infant, Extremely Premature; D007231:Infant, Newborn; D007234:Infant, Premature; D019102:Infant, Very Low Birth Weight; D008297:Male; D012189:Retrospective Studies; D014640:Vancomycin / Q000008:administration & dosage* / Q000493:pharmacokinetics
D000900:Anti-Bacterial Agents; D014640:Vancomycin