Achieving therapeutic vancomycin levels in pediatric patients

Abstract

Background: Vancomycin is widely used to treat infections caused by methicillin-resistant Staptrylocoaw aureus. Data for dosing and monitoring of this drug in pediatric patients are lacking, and clinicians who are treating children often follow guidelines established for adults. Objectives: To examine the total daily doses of vancomycin required to reach therapeutic trough levels (i.e., 10-20 mg/1.) in infants, children, and adolescents, and to assess the number of pediatric patients in whom therapeutic trough levels are achieved with current empiric doses (40-60 mg/kg daily). Methods: This chart review evaluated patients 1 month to 18 years of age for whom vancomycin was prescribed at a single institution between November 2011 and October 2012. Patients' demographic characteristics, vancomycin dosing parameters, and subsequent steady-state trough concentrations were analyzed. Results: Overall, the proportion of patients who reached therapeutic trough levels with current empiric doses was 39% (74 of 188). The mean total daily dose (± standard deviation) required to achieve therapeutic trough levels was 57.8 ± 11.5 mg/kg for patients 1 to 5 months of age, 68.9 ± 15.4 mg/kg for those 6 to 23 months of age, 65.8 ± 13.0 mg/kg for those 2 to 12 years of age, and 55.7 ± 11.8 mg/kg for those 13 to 18 years of age. Conclusions: Commun empiric vancomycin dosing regimens (40-60 mg/kg daily) are not high enough to achieve trough levels of 10-20 mg/1. in the majority of pediatric patients. Given these data, the authors suggest a starting dose of 60 mg/kg daily for patients 1 to 5 months of age and those 13 to 18 years of age and a starting dose of 70 nig/kg daily for patients 6 months to 12 years of age.