906. Determining Dosing Regimen of Vancomycin in Pediatric Patients to Reach Trough Concentrations of 10-20 mg/L
Session: Poster Abstract Session: Antimicrobial Utilization and Resistance in Children
Saturday, October 22, 2011
Room: Poster Hall B1
Handouts
  • 906_PoojaShah.pdf (550.1 kB)
  • Background: The recommendation to target vancomycin trough concentrations between 10-20 mg/L in adults is often extrapolated to pediatric patients. However, the vancomycin dosing recommended by standard pediatric dosing references is usually insufficient to reach this target trough concentration (TTC).  The purpose of this study was to determine a dose of vancomycin that enabled pediatric patients to reach TTC > 10 mg/L by steady state.  Subgroups evaluated included pediatric oncology patients and patients on diuretics. A cohort study was conducted in neonates. Time to reach TTC was evaluated.  A safety analysis observed for nephrotoxicity.

    Methods: A retrospective review of patients ≤18 years old admitted to The Joseph M. Sanzari Children’s Hospital at Hackensack University Medical Center was conducted. A computer-generated list identified patients on vancomycin from May 1, 2010 to March 1, 2011. Data collection included demographics and vancomycin dosing. Renal function was assessed by changes in serum creatinine.

    Results: The final analysis included 79 courses of vancomycin therapy in pediatrics. Twenty six of 79 courses reached troughs >10 mg/L in pediatrics.  The overall average dose required to reach TTC was 66 mg/kg/day and 70.7 mg/kg/day in patients < 60 kg.  Twelve courses in pediatric oncology patients reached TTC requiring an average dose of 68.6 mg/kg/day.  Five courses in the diuretic group reached TTC with a dose of 65.6 mg/kg/day.  There was a statistically significant difference in median time to TTC between pediatric patients not receiving diuretics and those on diuretics, 104 hours and 64 hours (95% CI: 90 to 150 hours, p=0.0078), respectively. Linear regression revealed diuretics and dose are significant predictors of trough concentrations, Trough Level = 0.9715 + 0.1336 (dose) + 6.5491 (diuretics); R2=0.2597; p = <0.0001.  Eleven of 13 courses in neonates reached troughs >10 mg/L.  Six courses required doses of 10 mg/kg/dose q8h and 5 courses required 10 mg/kg/dose q6h.  No nephrotoxicity was observed.

    Conclusion: Doses required to reach TTC as observed in this study are inconsistent with those recommended by standard pediatric references.  Higher empiric vancomycin dosing in pediatric and neonatal patients would allow TTC to be reached sooner.


    Subject Category: P. Pediatric and perinatal infections

    Pooja Shah, PharmD1, Danielle Coppola, PharmD2, Lisa Degnan, PharmD, BCPS2, Arpi G. Kuyumjian, PharmD1 and Kevin Slavin, MD3, (1)Pharmacy, Hackensack Univ. Medical Center, Hackensack, NJ, (2)Pharmacy Practice Administration, Ernest Mario Sch. of Pharmacy-Rutgers, The State Univ. of New Jersey, Piscataway, NJ, (3)Section of Pediatric Infectious Diseases, Hackensack Univ. Medical Center, Hackensack, NJ

    Disclosures:

    P. Shah, None

    D. Coppola, None

    L. Degnan, None

    A. G. Kuyumjian, None

    K. Slavin, None

    Findings in the abstracts are embargoed until 12:01 a.m. EST Thursday, Oct. 20 with the exception of research findings presented at IDSA press conferences.