Optimizing Vancomycin Monitoring in Pediatric Patients.
Alsultan, Abdullah PharmD, PhD *,+; Abouelkheir, Manal PharmD ++; Alqahtani, Saeed PharmD, PhD *,+; Aljabri, Ahmad PharmD ++; Somily, Ali M. MD [S]; Alsubaie, Sarah MD [P]; Alrabiaah, Abdulkarim MD [P]; Bukhari, Elham MD [P]; Alzamil, Fahad MD [P]
Pediatric Infectious Disease Journal.
37(9):880-885, September 2018.
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Background: Several studies have reported that trough levels may not be optimal for monitoring vancomycin therapy, because of overexposure and nephrotoxicity risks. Therefore, we developed a population pharmacokinetic model to optimize vancomycin dosing and monitoring in pediatrics.
Methods: Data were retrospectively collected on 76 pediatric patients 1-12 years of age, admitted to general pediatric wards or intensive care units at King Saud University Medical City, Riyadh, Saudi Arabia. The predictability of 3 methods for calculating the area under the curve (AUC) at steady state was assessed for optimum vancomycin therapy monitoring. The 3 methods were simple linear regression, Bayesian approach and the 2-sample pharmacokinetic equation method. We also used Monet Carlo simulations to evaluate the dosing of vancomycin.
Results: A 1-compartment model adequately described the data. A strong correlation occurred between the observed and predicted AUC from 0 to 24 hours (AUC0-24h) calculated using the Bayesian approach with a trough sample only or pharmacokinetic equations based on 2 measured samples (R2 = 0.93 and 0.92, respectively). For the simple linear regression method with a trough sample only, the predicted AUC0-24h at steady state with vancomycin trough levels of 10, 15 and 20 [micro]g/mL were 413, 548 and 714 [micro]g[middle dot]hour/mL, respectively. The target AUC0-24h above 400 was achieved in 46% and 95% of individuals with trough values of 7-11 and 11-15 [micro]g/mL, respectively. Monte Carlo simulations showed that 60-80 mg/kg/d doses are needed to optimize vancomycin therapy.
Conclusions: In conclusion, targeting vancomycin trough levels above 15 [micro]g/mL in pediatrics would overshoot the target AUC0-24h above 400 and expose them to unnecessary adverse events.
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