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Consider age, MRSA patterns before selecting vacomycin for children
Vancomycin dosages ranging from 60 mg/kg to 70 mg/kg per day were necessary to achieve optimal drug exposure needed to treat serious infections in children, according to results of a new study.
In addition, targeted use of this medication by area under the curve/minimum inhibitory concentrations (AUC/MIC), as opposed to trough concentration, may be necessary to achieve optimal dosages, according to Jennifer Le, PharmD, MAS, FCCP, BCPS-ID, and colleagues at UCSD Skaggs School of Pharmacy and Pharmaceutical Sciences.
Jennifer Le
The researchers analyzed modeling data on 702 children aged older than 3 months who received vancomycin between 2003 and 2011. This is the largest study to-date to evaluate vancomycin pharmacokinetics in hospitalized children.
Monte Carlo simulation indicated that the initial median dose of 44 mg/kg/day (range: 39 mg/kg/day to 52 mg/kg/day) was inadequate in most children. Regimens of 60 mg/kg/day for patients aged 12 years and older and 70 mg/kg/day for those aged younger than 12 years achieved target AUC/MIC in about 75% of virtual patients and trough concentrations of ≥15 mcg/mL in about 45% of virtual patients, according to the findings.
Le and colleagues noted that their data demonstrated the importance of considering age, kidney function and local methicillin-resistant Staphylococcus aureus susceptibility patterns before deciding on a vancomycin regimen for children.
Jennifer Le, PharmD, MAS, FCCP, BCPS-ID, can be reached at UCSD Skaggs School of Pharmacy and Pharmaceutical Sciences, 9500 Gilman Drive, MC 0714 La Jolla, CA 92093-0714; email: jenle@ucsd.edu.
Disclosure:Le reports no relevant financial disclosures.
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