Program Schedule

Evaluation of Vancomycin Loading Dose in Pediatric Patients

Session: Poster Abstract Session: Pediatric Antimicrobial Stewardship
Thursday, October 9, 2014
Room: The Pennsylvania Convention Center: IDExpo Hall BC

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 VAN dosing in children is uncertain.


Methods: A retrospective analysis of VAN dosing, subsequent trough attainment, and demographic data was completed for pediatric inpatients > 3 months of age who received a VAN loading dose 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: 19 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 after at least 3 maintenances doses in 58% (11/19) patients, and as late as before the 8th dose in 1 patient.  All patients received only 1 loading dose. The median loading dose administered was 25 mg/kg (range: 18 27.8) with a median maintenance dose of 15 mg/kg every 6 hours. For the entire study population, the initial median trough concentration was 10.9 mg/L (range: <5 23.8). 52.5% (10/19) had trough concentrations between 10-20 mg/L and 36.8% (7/19) between 5-10 mg/L. Only 1 patient (5.3%) had an undetectable (<5 mg/L) trough concentration; however, the level was drawn ~45 minutes late. Additionally, 1 patient (5.3%) reported a supratherapeutic trough concentration of 23.8; however, no elevations in serum creatinine were noted. Of those who were initiated on a maintenance dose of 15 mg/kg/dose every 6 hours after the initial loading dose, the initial median trough concentration was 10.4 mg/L (range: <5 23.8). No cases of nephrotoxicity were reported.

Conclusion:  Use of a loading dose was safe and resulted in achievement of goal initial median trough concentrations of 10 20 mg/L in this study population. This may suggest that more aggressive and standardized dosing strategies may benefit pediatric patients in achieving early target trough concentration on VAN therapy.    

Figure 1:

Palak H. Bhagat, PharmD, BCPS, Pharmacy, University of Chicago Medicine, Chicago, IL and Allison H. Bartlett, MD, MS, Pediatrics (Infectious Diseases), University of Chicago Medicine, Chicago, IL


P. H. Bhagat, None

A. H. Bartlett, None

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