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. 2021;26(1):56-61.
doi: 10.5863/1551-6776-26.1.56. Epub 2021 Jan 4.

Achieving Vancomycin Troughs Within Goal Range in Low Birth Weight Neonates

Sadie B Stone, Kim Benner, Aubrey Utley, Paul MacLennan, Carl H Coghill 3rd

Achieving Vancomycin Troughs Within Goal Range in Low Birth Weight Neonates

Sadie B Stone et al. J Pediatr Pharmacol Ther. 2021.

Abstract

Objective: Vancomycin is commonly used in the neonatal population to treat Gram-positive bacterial infections. Despite frequent use, consensus on the ideal dosing regimen in low birth weight (LBW) neonates is lacking. The objective of this research is to determine how frequently vancomycin troughs within goal range (10-20 mg/L) are achieved with empiric dosing in critically ill neonates and infants weighing less than 2500 g.

Methods: This retrospective review evaluated LBW infants who were admitted to a level IV NICU from January 2015 to December 2016. Patients were included if they had a vancomycin trough sample collected at steady state (after at least 3 doses). Three trough cohorts (subtherapeutic: <10 mg/L, therapeutic: 10-20 mg/L, and supratherapeutic: >20 mg/L) were compared with 1-way ANOVA for continuous data and a chi-square analysis for categorical data.

Results: A total of 74 patients were included, with a mean birth weight (BW) of 819.7 ± 355.4 g and a mean gestational age (GA) of 26.4 ± 3.7 weeks. Only 27 patients (36.5%) had therapeutic vancomycin trough concentrations. Subtherapeutic troughs were recorded in 40 patients (54.1%), while supratherapeutic troughs were recorded in 7 patients (9.5%). Although there was no difference between the initial dose, initial frequency was significantly different between cohorts (p = 0.04).

Conclusion: Empiric dosing regimens do not produce vancomycin troughs within the goal range in most LBW patients.

Keywords: birth weight; gestational age; infant, newborn; intensive care units, neonatal; research; vancomycin.

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Conflict of interest statement

Disclosure. The authors declare no conflicts or financial interest in any product or service mentioned in the manuscript, including grants, equipment, medications, employment, gifts, and honoraria. The authors had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Figures

Figure.
Figure.
Flow diagram of study participant inclusion.
See this image and copyright information in PMC

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