2332. Higher Pediatric Vancomycin Dosing Trends Toward Improved Therapeutic Troughs
Session: Poster Abstract Session: Pediatric Bacterial Infections
Saturday, October 6, 2018
Room: S Poster Hall
Posters
  • Boeglin Ching-Vanco IDweek 2018.pdf (339.6 kB)
  • Background: Vancomycin is challenging to dose due to a narrow therapeutic index. Inadequate dosing undertreats dangerous infections, while high doses can cause Acute Kidney Injury (AKI).  Standard pediatric vancomycin dosing (40-60 mg/kg/day) often produces inadequate troughs. Our institution began permitting a higher initial vancomycin dose: 80 mg/kg/day for children 1 month to 12 years old, and 60 mg/kg/day for children ≥ 13 years old. This study aims to determine if higher dosing has increased the rate of therapeutic troughs or the rate of AKI.

    Methods: A retrospective review was conducted of patients < 18 years of age who were admitted to our institution and received vancomycin. 842 unique courses of vancomycin were identified and age, sex, race, vancomycin dosing, trough results, and creatinine data were abstracted. 450 records were excluded based on criteria of age < 1 month, pre-existing renal failure, or no measured troughs. 392 unique vancomycin courses for 340 unique patients were analyzed. Therapeutic troughs were defined as 10-20 µg/mL. Statistical analysis was performed using Chi-square test, Fisher’s exact test, and unpaired t-test.

    Results:

    Pre-Intervention

    Post-Intervention

    Change

    p-value

    Ages 1 month to 12 years

    Mean Initial Dose (mg/kg/day)

    62.6

    73.2

    10.6

    <0.001

    Initial Trough Therapeutic

    32.7%

    41.1%

    8.4%

    0.31

    Initial Trough Subtherapeutic

    63.0%

    55.5%

    -7.5%

    Initial Trough Supratherapeutic

    4.3%

    3.4%

    -0.9%

    AKI Rate

    20.9%

    8.1%

    -12.8%

    0.013

    Ages ≥ 13 years

    Mean Initial Dose (mg/kg/day)

    56.3

    54.9

    -1.4

    0.51

    Initial Trough Therapeutic

    40.9%

    32.5%

    -8.4%

    0.50

    Initial Trough Subtherapeutic

    59.1%

    67.5%

    8.4%

    Initial Trough Supratherapeutic

    0.0%

    0.0%

    0.0%

    AKI Rate

    22.6%

    12.0%

    -10.6%

    0.30

    Younger patients with higher vancomycin dosing attained an initial therapeutic trough in 41.1% vs. 32.7%.

    Conclusion: A higher initial vancomycin dose trended towards an improved rate of therapeutic troughs in children 1 month to 12 years old. There was no evidence of increase in the rate of AKI or supratherapeutic troughs. While vancomycin dosing remains challenging, a policy permitting higher initial dosing may more adequately treat dangerous infections without risking adverse effects. Further study of higher vancomycin dosing is warranted.

    August Boeglin, MD1, Len Yonemura, PharmD2, Marian Melish, MD3 and Natascha Ching, MD3, (1)Hawaii Pediatric Residency Program, Honolulu, HI, (2)Kapiolani Medical Center for Women and Children, Honolulu, HI, (3)University of Hawaii John A. Burns School of Medicine, Honolulu, HI

    Disclosures:

    A. Boeglin, None

    L. Yonemura, None

    M. Melish, None

    N. Ching, None

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 3rd with the exception of research findings presented at the IDWeek press conferences.