Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Comparative Study
. 2015 Jun 1;37(6):1340-51.
doi: 10.1016/j.clinthera.2015.05.006. Epub 2015 May 29.

Bayesian Estimation of Vancomycin Pharmacokinetics in Obese Children: Matched Case-Control Study

Jennifer Le  1 , Edmund V Capparelli  2 , Uzra Wahid  2 , Yi Shuan S Wu  2 , Gale L Romanowski  3 , Tri M Tran  4 , Austin Nguyen  4 , John S Bradley  5
Affiliations
Comparative Study

Bayesian Estimation of Vancomycin Pharmacokinetics in Obese Children: Matched Case-Control Study

Jennifer Le et al. Clin Ther. .

Abstract

Purpose: The study objective was to compare different body size descriptors that best estimate vancomycin Vd and clearance (CL).

Methods: Patients between 3 months and 21 years old who received vancomycin for ≥48 hours from 2003 to 2011 were evaluated in this matched case-control study. Cases had body mass index in the ≥85th percentile; controls were nonobese individuals who were matched by age and baseline serum creatinine (SCr). Using a 1-compartment model with first-order kinetics, Bayesian post hoc individual Vd and CL were estimated.

Findings: Analysis included 87 matched pairs with 389 vancomycin serum concentrations. Median ages were 10.0 (interquartile range [IQR], 4.8-15.2) years for cases (overweight and obese children) and 10.2 (IQR, 4.5-14.8) years for controls (normal-weight children). Median weights were 44.0 (IQR, 23.4-78.1) kg for cases and 31.3 (IQR, 16.8-47.1) kg for controls. Mean (SD) for the baseline SCr values were also similar between the groups: 0.51 (0.22) (IQR, 0.34-0.67) mg/dL and 0.48 (0.20) (IQR, 0.30-0.60) mg/dL for the cases and controls, respectively. Actual weight and allometric weight (ie, weight(0.75)) were used in the final model to estimate Vd and CL, respectively. The mean Vd and CL, based on weight, for cases were lower than controls by 0.012 L/kg and 0.014 L/kg/h, respectively.

Implications: In obese children, actual weight and allometric weight are reasonable, convenient estimations of body fat to use for estimating vancomycin Vd and CL, respectively. However, these pharmacokinetic differences between obese children and those with normal weights are small and may not likely to be clinically relevant in dose variation.

Keywords: Staphylococcus aureus; antibiotics; children; obesity; pediatrics; pharmacokinetics; vancomycin.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Effect of age (A and B) and serum creatinine (C) on vancomycin Vd. R2 represents Pearson correlation, and curves are 90% Loess fit. Error bars indicate 1 SD.
Figure 1
Figure 1
Effect of age (A and B) and serum creatinine (C) on vancomycin Vd. R2 represents Pearson correlation, and curves are 90% Loess fit. Error bars indicate 1 SD.
Figure 1
Figure 1
Effect of age (A and B) and serum creatinine (C) on vancomycin Vd. R2 represents Pearson correlation, and curves are 90% Loess fit. Error bars indicate 1 SD.
Figure 2
Figure 2
Effect of age (A and B) and serum creatinine (C) on vancomycin clearance. R2 represents Pearson correlation, and curves are 90% Loess fit. Error bars indicate 1 SD.
Figure 2
Figure 2
Effect of age (A and B) and serum creatinine (C) on vancomycin clearance. R2 represents Pearson correlation, and curves are 90% Loess fit. Error bars indicate 1 SD.
Figure 2
Figure 2
Effect of age (A and B) and serum creatinine (C) on vancomycin clearance. R2 represents Pearson correlation, and curves are 90% Loess fit. Error bars indicate 1 SD.
Figure 3
Figure 3
Observed versus individual (A) and population (B) predicted concentrations.
Figure 3
Figure 3
Observed versus individual (A) and population (B) predicted concentrations.
Figure 4
Figure 4
Plots of residuals in concentrations. Conditional weighted residual plot with 90% Loess fit (A) and natural log plot (B).
Figure 4
Figure 4
Plots of residuals in concentrations. Conditional weighted residual plot with 90% Loess fit (A) and natural log plot (B).
See this image and copyright information in PMC

References

    1. Liu C, Bayer A, Cosgrove SE, et al. Clinical practice guidelines by the infectious diseases society of america for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children. Clin Infect Dis. 2011;52:e18–e55. - PubMed
    1. Moffett BS, Kim S, Edwards MS. Vancomycin dosing in obese pediatric patients. Clin Pediatr. 2011;50:442–446. - PubMed
    1. Nassar L, Hadad S, Gefen A, et al. Prospective evaluation of the dosing regimen of vancomycin in children of different weight categories. Curr Drug Saf. 2012;7:375–381. - PubMed
    1. Blouin RA, Bauer LA, Miller DD, et al. Vancomycin pharmacokinetics in normal and morbidly obese subjects. Antimicrob Agents Chemother. 1982;21:575–580. - PMC - PubMed
    1. Vance-Bryan K, Guay DR, Gilliland SS, et al. Effect of obesity on vancomycin pharmacokinetic parameters as determined by using a Bayesian forecasting technique. Antimicrob Agents Chemother. 1993;37:436–440. - PMC - PubMed

Publication types

MeSH terms