799. Improving Vancomycin Dosing in the Pediatric Population
Session: Poster Abstract Session: Antimicrobial Agents: PK/PD Studies
Friday, October 9, 2015
Room: Poster Hall
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  • Background: Vancomycin dosing has been an area of uncertainty in the pediatric population.  Recommendations are to achieve vancomycin trough levels between 10-20 mg/L, though studies have had varying success with standard dosing to reach these goals.  The purpose of this study was to evaluate the effectiveness of reaching therapeutic levels using  standard vancomycin dosing in the pediatric population at Our Lady of the Lake Children’s Hospital (OLOLCH) and compare it to a higher standardized starting vancomycin dose in our population.

    Methods:  Initially, standardized forms utilized by pharmacy in tracking vancomycin usage allowed a retrospective review of all OLOLCH patients receiving vancomycin.  Vancomycin dosing  was increased from 60 milligram/kilogram/day (mg/kg/day) to 70 mg/kg/day.  After excluding patients with documented renal dysfunction and those who never had a vancomycin level drawn, data regarding patient’s age, associated diagnoses, vancomycin dosing and trough levels, and laboratory results were analyzed.

    Results: Of the 206 patients given 60 mg/kg/day, 149 (72%) were subtherapeutic, 51 (25%) were therapeutic, and 6 (3%) were supratherapeutic using initial trough levels. Fifty patients were given 70 mg/kg/day – 31 (62%) were subtherapeutic, 14 (28%) were therapeutic, and 5 (10%) were supratherapeutic.  The median trough level was 7.2 mg/L and 8.3 mg/L for the 60 mg/kg/day and 70 mg/kg/day doses, respectively (p<0.001).  While there was a larger percent of patients who had supratherapeutic levels on the higher dose, only 1 (a 29 day old) of 5 had a trough greater than 22 mg/L.  No patient had vancomycin toxicity or renal impact in either group. Anecdotally, a larger percentage of patients in the higher dose group experienced redman syndrome.

    Conclusion: We were able to demonstrate a significantly higher vancomycin trough level with a higher starting dose of 70 mg/kg/day without negatively impacting renal function though likely producing increased incidence of drug reaction (i.e., Redman Syndrome).  However, most patients still had subtherapeutic trough levels though additional study and analyses is needed to determine if higher dosing is clinically beneficial.

    Michelle Jones, DO1, Rachel Mathews, PharmD1 and Michael Bolton, MD2, (1)Pediatrics, Our Lady of the Lake Children's Hospital, Baton Rouge, LA, (2)Section of Infectious Diseases, Our Lady of the Lake Children's Hospital, Baton Rouge, LA


    M. Jones, None

    R. Mathews, None

    M. Bolton, None

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 7th with the exception of research findings presented at the IDWeek press conferences.