Vancomycin prescription in neonates and young infants: toward a simplified dosage.
Arch Dis Child Fetal Neonatal Ed
; 96(5): F365-70, 2011 Sep.
Article
en En
| MEDLINE
| ID: mdl-21378399
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.
Texto completo:
1
Base de datos:
MEDLINE
Asunto principal:
Infecciones Bacterianas
/
Vancomicina
/
Antibacterianos
Tipo de estudio:
Observational_studies
/
Risk_factors_studies
Idioma:
En
Revista:
Arch Dis Child Fetal Neonatal Ed
Asunto de la revista:
PEDIATRIA
/
PERINATOLOGIA
Año:
2011
Tipo del documento:
Article