title: Assessment of optimal initial dosing regimen with vancomycin pharmacokinetics model in very low birth weight neonates.
abstract: BACKGROUND
  Pharmacokinetic of vancomycin in very low birth weight neonates showed big variety, and limited data were available due to very minor population. These facts make it difficult to adjust its optimal initial dosage. Therefore, this study was to develop optimal dosing regimen of vancomycin in very low birth weight neonates.
  
  
  METHODS
  Between 2010 and 2015, low birth weight neonates (≤1500 g) were included in a population pharmacokinetics analysis. Based on the pharmacokinetic parameters we estimated, we simulated individual blood concentrations of vancomycin and evaluated the probability of its pharmacokinetics/pharmacodynamics (PK/PD) target attainment, such as 24-h area under the concentration-time curve (AUC24)/MIC (≥400) and blood trough concentration (10-20 μg/mL), as primary measure for several dosing regimens by Monte Carlo simulation method.
  
  
  RESULTS
  Ten patients were prescribed vancomycin and detected its blood concentrations as routine pharmacy practice to adjust the dosage. A one-compartment model was used and clearance significantly correlated with serum creatinine and the volume of infusion. In this model, vancomycin dose at 10 mg/kg three times a day (TID) was predicted to result 86.7% of neonates for an MIC of 1 μg/mL achieving AUC/MIC of ≥400 and 30.6% of the neonates for an MIC of 2 μg/mL. Moreover, the probability of reaching the target trough concentration was 70.5% for patients treated with vancomycin 10 mg/kg TID.
  
  
  CONCLUSIONS
  We recommended vancomycin 10 mg/kg TID as initial dosage regimens for low birth weight neonates infected with the pathogens showed MIC of ≤1 μg/mL.
authors.affiliation: Department of Infection Control and Prevention, Aichi Medical University School of Hospital, Japan; Department of Pharmacy, Aichi Medical University School of Hospital, Japan.
authors.forename: Hideo
authors.initials: H
authors.lastname: Kato
authors.affiliation: Department of Infection Control and Prevention, Aichi Medical University School of Hospital, Japan; Department of Pharmacy, Aichi Medical University School of Hospital, Japan. Electronic address: hagimao@aichi-med-u.ac.jp.
authors.forename: Mao
authors.initials: M
authors.lastname: Hagihara
authors.affiliation: Department of Infection Control and Prevention, Aichi Medical University School of Hospital, Japan.
authors.forename: Naoya
authors.initials: N
authors.lastname: Nishiyama
authors.affiliation: Department of Infection Control and Prevention, Aichi Medical University School of Hospital, Japan.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Koizumi
authors.affiliation: Department of Infection Control and Prevention, Aichi Medical University School of Hospital, Japan.
authors.forename: Hiroshige
authors.initials: H
authors.lastname: Mikamo
authors.affiliation: Department of Infection Control and Prevention, Aichi Medical University School of Hospital, Japan; Department of Pharmacy, Aichi Medical University School of Hospital, Japan.
authors.forename: Katsuhiko
authors.initials: K
authors.lastname: Matsuura
authors.affiliation: Department of Infection Control and Prevention, Aichi Medical University School of Hospital, Japan.
authors.forename: Yuka
authors.initials: Y
authors.lastname: Yamagishi
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D019540:Area Under Curve; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight; D008297:Male; D008826:Microbial Sensitivity Tests / Q000379:methods; D008954:Models, Biological; D009010:Monte Carlo Method; D012189:Retrospective Studies; D014640:Vancomycin / Q000008:administration & dosage* / Q000097:blood / Q000493:pharmacokinetics*
chemical_list: D000900:Anti-Bacterial Agents; D014640:Vancomycin
keywords: Pharmacodynamics; Pharmacokinetics; Population pharmacokinetic analysis; Vancomycin; Very low birth weight neonates