Therapeutic monitoring of vancomycin according to initial dosing regimen in pediatric patients.
10.3345/kjp.2010.53.12.1000
- Author:
Dae Il KIM
1
;
Mi Sun IM
;
Jin Hyoung CHOI
;
Jina LEE
;
Eun Hwa CHOI
;
Hoan Jong LEE
Author Information
1. Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea. eunchoi@snu.ac.kr
- Publication Type:Original Article
- Keywords:
Vancomycin;
Drug monitoring;
Child
- MeSH:
Catheter-Related Infections;
Child;
Drug Monitoring;
Endocarditis;
Humans;
Meningitis;
Methicillin Resistance;
Methicillin-Resistant Staphylococcus aureus;
Republic of Korea;
Staphylococcus epidermidis;
Vancomycin
- From:Korean Journal of Pediatrics
2010;53(12):1000-1005
- CountryRepublic of Korea
- Language:English
-
Abstract:
PURPOSE: This study aimed to determine the optimal initial vancomycin dose to achieve appropriate trough levels in pediatric patients. METHODS: We analyzed clinical data for 309 children treated with intravenous vancomycin between 2004 and 2009 at 2 different hospitals in South Korea. The patients were 1-16 years old and exhibited normal renal function. Patient data, including reason for treatment and initial dosing regimen, were reviewed. Two subgroups were identified and compared according to initial vancomycin dose: 40 (35-45) mg/kg/day and 60 (55-65) mg/kg/day. Trough levels were obtained at steady state after at least 4 doses of vancomycin. RESULTS: Patients who received vancomycin had post-operation or wound-related infections (37.2%), localized infection (12.9%), catheter-related infections (9.4%), meningitis (8.7%), or endocarditis (6.8%). Pathogens were confirmed in 79 cases: 28 cases of methicillin-resistant Staphylococcus epidermidis (35.4%) and 25 of methicillin-resistant Staphylococcus aureus (31.6%). Out of the 309 patients, 201 (65%) received vancomycin at 40 mg/kg/day and 108 (35%) at 60 mg/kg/day. Average trough concentrations were significantly different between the groups (P<0.001). Trough levels over 10 mg/L were less likely to be achieved in the 40 mg/kg/day group (14%) than in the 60 mg/kg/day group (49%) (P<0.001). There were no differences in renal function deterioration between the groups. CONCLUSION: A common vancomycin dosing regimen, 40 mg/kg/day, was not high enough to achieve trough levels of over 10 mg/L in pediatric patients. Careful drug monitoring must be performed, and increasing initial dose of vancomycin should be considered in pediatric patients.
