title: Correlation of a Vancomycin Pharmacokinetic Model and Trough Serum Concentrations in Pediatric Patients.
abstract: BACKGROUND
  Vancomycin trough concentrations specific to pediatric patients have yet to be validated that achieve an area under the curve (AUC) over 24 hours to minimum inhibitory concentration (MIC) ratio ≥400. The primary objective of this study was to validate a pharmacokinetic model in a pediatric hospital and determine the correlation between a calculated AUC/MIC ratio and measured trough vancomycin concentration.
  
  
  METHODS
  A retrospective evaluation of patients aged 3 months to 18 years prescribed vancomycin at a pediatric hospital between January 2012 and June 2013. The correlation between patient-specific AUC/MIC and measured vancomycin trough concentration was assessed.
  
  
  RESULTS
  Forty pediatric patients with 40 vancomycin trough concentrations and documented Staphylococcus aureus cultures were included in the study. Median age was 8.5 (interquartile range, 2-14.3) years, median weight 28.7 (range, 14-50.2) kg, and mean baseline serum creatinine 0.51 ± 0.3 mg/dL. The mean daily dose of vancomycin prescribed was 58 ± 13.8 mg/kg/d. The mean vancomycin trough concentration was 11 ± 5.5 mcg/mL, and the mean AUC/MIC was 534 ± 373. No correlation was found between trough concentration and AUC/MIC (r = 0.082, p = 0.07).
  
  
  CONCLUSIONS
  This study validates the clinical applicability of a pharmacokinetic model for calculating vancomycin clearance to determine patient-specific AUC over 24 hours in pediatrics. Trough concentrations associated with proposed therapeutic AUC/MIC ratios were lower than reported in the adult population. Further research is needed to determine if AUC/MIC, trough concentration, or both is best for monitoring therapeutic efficacy of vancomycin in pediatrics.
authors.affiliation: From the *Department of Pharmacy, Georgia Regents Medical Center, Augusta, Georgia; †University of Georgia College of Pharmacy, Augusta, Georgia; and ‡Department of Pediatrics, Medical College of Georgia, Georgia Regents University, Augusta, Georgia.
authors.forename: Cady
authors.initials: C
authors.lastname: Ploessl
authors.forename: Christopher
authors.initials: C
authors.lastname: White
authors.forename: Kalen
authors.initials: K
authors.lastname: Manasco
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000097:blood* / Q000493:pharmacokinetics* / Q000494:pharmacology / Q000627:therapeutic use; D019540:Area Under Curve; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008826:Microbial Sensitivity Tests; D008954:Models, Biological; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000188:drug therapy / Q000382:microbiology; D013211:Staphylococcus aureus / Q000187:drug effects; D014640:Vancomycin / Q000097:blood* / Q000493:pharmacokinetics* / Q000494:pharmacology / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D014640:Vancomycin