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Vancomycin prescription in neonates and young infants: toward a simplified dosage
  1. C Oudin1,
  2. R Vialet1,
  3. A Boulamery2,
  4. C Martin3,
  5. N Simon2
  1. 1Réanimation Pédiatrique et Néonatale, Département d’Anesthésie-Réanimation, Hôpital Nord, Assistance-Publique Hôpitaux de Marseille, Marseille, France
  2. 2Département de Pharmacologie, Hôpital de la Timone, Assistance-Publique Hôpitaux de Marseille, Université de la Méditerranée, Marseille, France
  3. 3Département d’Anesthésie-Réanimation, Hôpital Nord, Assistance-Publique Hôpitaux de Marseille, Marseille, France
  1. Correspondence to Renaud Vialet, Réanimation Pédiatrique et Néonatale, Hôpital Nord, Chemin des Bourely, 13 915 Marseille, France; renaud.vialet{at}ap-hm.fr

Abstract

Background There is no consensus on vancomycin dosing in newborns and young infants.

Objective The first objective was to assess the efficiency of a simplified dosing regimen with a cohort study. The secondary objective was to examine pharmacokinetic data to determine how this simplified dosing could be improved.

Methods All neonates admitted to our intensive care unit and treated with vancomycin were included in the pharmacokinetic study (PK group, 83 treatments, 156 measurements). The vancomycin dosing regimen consisted of a loading dose of 7 mg/kg, followed by a constant continuous dose of 30 mg/kg/day. The target serum vancomycin concentration ranged from 10 mg/l to 30 mg/l. Data from patients whose medications followed the scheduled dosing without modifications or prescription errors (actual dosing group: 62 treatments, 108 measurements) were analysed separately. A population pharmacokinetic analysis was performed (PK group) to simulate several vancomycin dosings.

Results Prescription errors were found in 10 of 83 treatments (12%). In the actual dosing group, 89.2% of vancomycin measurements were within the target range. Serum creatinine remained stable throughout treatment. Vancomycin concentrations varied widely. The modified regimen for a target vancomycin concentration of 25 mg/l consisted of a bolus of 20 mg/ kg followed by continuous infusion of 30 mg/kg.

Conclusion Our pharmacokinetic data and bedside results suggest that a simplified schedule of vancomycin can achieve the targeted drug concentrations in most patients while avoiding secondary renal toxicity. The proposed new dosing scheme should be validated in a drug survey, but due to pharmacokinetic variability, still requires therapeutic drug monitoring.

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Footnotes

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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