An evaluation of vancomycin dosing for complicated infections in pediatric patients.
OBJECTIVE
To determine the incidence with which a vancomycin dosing regimen of 15 mg/kg per dose every 6 hours achieves steady-state trough concentrations of 15 to 20 mg/L in pediatric patients with complicated infections.


METHODS
We performed a retrospective chart review for patients admitted to our children's hospital between July 1, 2009, and June 30, 2011. Patients were included if they were between 1 month and 18 years of age, had at least 1 steady-state vancomycin trough obtained, received an initial vancomycin dose of 15 mg/kg per dose every 6 hours, and were being treated for a diagnosis of meningitis, pneumonia, osteomyelitis, bacteremia/sepsis, or endocarditis.


RESULTS
Seventy-four patients were enrolled, mean age of 4.2±3.9 years and weight of 17.0±11.2 kg. Five (6.8%) patients obtained an initial trough of 15 to 20 mg/L. Patients between 1.0 and 5.9 years of age were significantly less likely to achieve an initial trough of 15 to 20 mg/L compared with other age groups evaluated (P=.041). Thirty-four patients with initial subtherapeutic troughs received a dose adjustment and a follow-up vancomycin trough. Of these patients, 15 (44.1%) achieved a trough between 15 and 20 mg/L. The median dose for patients achieving a therapeutic trough at any point during the study was 80 mg/kg per day.


CONCLUSIONS
A vancomycin dosing regimen of 15 mg/kg per dose every 6 hours is not likely to achieve a trough concentration of 15 to 20 mg/L in pediatric patients with complicated infections. An initial regimen of 80 mg/kg per day for these patients may be more likely to result in therapeutic steady-state concentrations of vancomycin.
Auburn University Harrison School of Pharmacy, Auburn, Alabama; durhash@auburn.edu.
Spencer H
SH
Durham
St. Joseph's Children's Hospital, Tampa, Florida;
Marroyln L
ML
Simmons
Vanderbilt University Medical Center, Nashville, Tennessee; and.
Diana W
DW
Mulherin
PICU, Children's Hospital at Sacred Heart, Florida State University School of Medicine, Pensacola, Florida.
Jason A
JA
Foland
D000293:Adolescent; D000407:Alabama; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000493:pharmacokinetics*; D019540:Area Under Curve; D001424:Bacterial Infections / Q000188:drug therapy*; D002648:Child; D002675:Child, Preschool; D004334:Drug Administration Schedule; D005260:Female; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D012189:Retrospective Studies; D014640:Vancomycin / Q000008:administration & dosage* / Q000493:pharmacokinetics*
D000900:Anti-Bacterial Agents; D014640:Vancomycin
child; infection; pediatrics; pharmacokinetics; vancomycin; vancomycin serum concentrations