Work

Monitoring of Serum Vancomycin Concentrations in Pediatric Patients

Year: 2008

Type: article

Abstract: Background: Vancomycin is a glycopeptide antibiotic that kills gram positive bacteria by interfering with cell wall synthesis. The necessity for monitoring serum vancomycin concentrations (SVC) has recently been noticed at many institutions because original concerns for nephorotoxicity have been largely alleviated. We evaluated the SVCs monitoring in pediatric patients, in an effort to identify the variables affecting vancomycin pharmacokinetics; the sub-therapeutic or toxic range. Methods: We reviewed the medical records of all patients older than 60 days of age admitted to Children Medical Center who were received interavenous vancomycin between July 2003 and December 2005. Details of vancomycin therapy, dosage and blood sampling times were obtained. Because pharmacokinetic determination for children with cancer may be different, this group was evaluated separately. Results: During the study, 167 infants and children without cancer and 42 cancerous patients, aged from 3 months to 17.5 years were treated with vancomycin for the various infections. In 93% children without cancer, peak SVCs was in an adequate therapeutic range with the highest level of 55 μg/ml and lowest of 8 μg/ml. For children with cancer, peak SVCs was below 10 μg/ml in 10% cases, and trough values <5 μg/ml in 21% cases. Conclusion: Vancomycin remains an effective antibiotic with infrequent discontinuations due to adverse events. Monitoring SVCs should be considered for patients with cancer, neonates, abnormal renal function, those receiving concurrent nephrotoxic drugs such as aminoglycosides and those receiving higher than usual dosages. This empirical dosing method can construct safe and effective vancomycin dosage regimens and help to reduce the toxicity.

Source: International Journal of Infectious Diseases

DOI: 10.1016/j.ijid.2008.05.193