162. Vancomycin Loading Dose in Pediatric Patients Receiving Intermittent Vancomycin Dosing
Session: Poster Abstract Session: Antimicrobial Use in Children
Thursday, October 3, 2013
Room: The Moscone Center: Poster Hall C
Posters
  • IDWeek_2013 - Vanco LD_final_three.pdf (682.0 kB)
  • Background:

    In adult patients, a loading dose of vancomycin (VAN) has been shown to be safe and effective in improving the likelihood of attaining a desirable initial trough level (10-20 mg/L).  Despite many years of experience, the appropriate PK/PD parameter to predict efficacy of vancomycin dosing in children is uncertain. We examined VAN dosing and subsequent troughs in a pediatric population to evaluate the effect of a loading dose.

    Methods:

    A retrospective analysis of VAN dosing, subsequent trough attainment, and demographic data was completed for  pediatric inpatients > 3 months of age who received IV VAN between 12/15/2012-4/1/2013 and had ≥ 1 recorded steady-state trough level.   Only the first course of VAN for each patient was included in the analysis.   Patients on VAN prior to admission or with renal dysfunction were excluded. 

    Results:

    45 patients were identified for inclusion in the study. Figure 1 shows the dosing strategy and initial trough level for each patient. Initial VAN troughs were obtained before the 4th dose in 60% (27/45) patients, and as late as before the 9th dose.  For those patients who received a loading dose of 18-25 mg/kg (n=6), the median initial trough was 11.3 mg/L (range 8.3-13.9); 0/6 initial troughs were supratherapeutic (> 20 mg/L). For those who did not receive a loading dose (n=39), median initial trough was 8.5 mg/L (range <5-22.6); 7/39 (18%) initial troughs were undetectable (<5 mg/L); 2/39 (5.7%) initial troughs were supratherapeutic. Four patients had VAN dose increased prior to obtaining a level. All of these patients were started on VAN overnight, when pharmacist coverage is limited. Median doses were increased from 10 mg/kg to 17.5 mg/kg once pharmacist review of the order occurred.  

     

    Conclusion:

    Loading doses of VAN result in higher initial VAN troughs in pediatric patients.   Conventional pediatric dosing strategies (no loading dose) resulted in initial VAN trough <10 mg/L in 61.5% (24/39) patients. This project was limited by the lack of standardization in timing of VAN level attainment.  However, use of a loading dose was safe and resulted in higher initial troughs in this study population and suggests that more aggressive and standardized dosing strategies may benefit pediatric patients on VAN.    

     

    Allison H. Bartlett, MD, MS, Pediatrics (Infectious Diseases), The University of Chicago Medicine, Chicago, IL, Danielle Brown-Alm, PharmD, BCPS, Pharmacy, University of Chicago Medicine/Comer Children's Hospital, Chicago, IL, Emily Landon, MD, Infectious Diseases and Global Health, The University of Chicago Medicine, Chicago, IL, Benjamin D. Brielmaier, PharmD, The University of Chicago Medicine, Chicago, IL and Palak H. Bhagat, PharmD, BCPS, Pharmacy, University of Chicago Medicine, Chicago, IL

    Disclosures:

    A. H. Bartlett, None

    D. Brown-Alm, None

    E. Landon, None

    B. D. Brielmaier, None

    P. H. Bhagat, None

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