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. 2024 Sep 11;24(1):575.
doi: 10.1186/s12887-024-05048-8.

An evaluation of the empirical vancomycin dosing guide in pediatric cardiology

Yousif S Alakeel  1   2   3   4 , Yazeed Alahmed  5   6 , Ghadah Alanazi  7   5 , Bushra Alawbathani  7   5 , Kadi Alshutwi  7   5 , Meshary Almeshary  8   5 , Fahad Aldhahri  8   7   5 , Meshal Alshakrah  5   9
Affiliations

An evaluation of the empirical vancomycin dosing guide in pediatric cardiology

Yousif S Alakeel et al. BMC Pediatr. .

Abstract

Background: Higher doses of vancomycin are currently prescribed due to the emergence of bacterial tolerance and resistance. This study aimed to evaluate the efficacy and safety of the currently adopted vancomycin dosing guide in pediatric cardiology.

Methods: This was a single-center prospective cohort study with pediatric cardiac patients, younger than 14 years, from June 2020 to March 2021. The patients received intravenous vancomycin (40 mg/kg/day divided every 6-8 h) according to the department's vancomycin medication administration guide (MAG) for at least three days.

Results: In total, 88 cardiac patients were included, with a median age of 0.82 years (IQR: 0.25-2.9), and 51 (58%) received cardiopulmonary bypass surgery (CPB). The majority (71.6%, n = 61) achieved a serum vancomycin level within the therapeutic range (7-20 mg/L). Infants, young children, and children exposed to CPB surgery had an increased incidence of subtherapeutic vancomycin levels, [7 (29.2%); P = 0.033], [13 (54.2%); P = 0.01], and [21 (87.5%); P = 0.009] respectively. After the treatment, 8 (10%) patients had an elevated Serum creatinine (SCr) and 2 (2.5%) developed acute kidney injury (AKI). However, no significant difference was found between the patients developing AKI or an elevated SCr and the group who did not, in terms of clinical, therapeutic, and demographic characteristics, except for the decreased incidence of SCr elevation in patients receiving an ACE inhibitor, [4 (36.4%); P = 0.036].

Conclusion: Our institution followed MAG recommendations; however, subtherapeutic serum concentrations were evident in infants, young children, and CPB patients. Strategies to prevent AKI should be investigated, as the possible causes have not been identified in this study.

Keywords: Cardiology; Cardiopulmonary bypass; Congenital heart disease; Dosing protocol; Pediatrics; Vancomycin.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
The study flow diagram. *MAG: medication administration guide, **ECMO: extracorporeal membrane oxygenator
Fig. 2
Fig. 2
Efficacy of the recommended initial dosing (40 mg/kg/day q6-8 h) endorsed in the medication administration guide (n = 88)
See this image and copyright information in PMC

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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 [published correction appears in Clin Infect Dis. 2011;53(3):319]. Clin Infect Dis. 2011;52(3):e18-e55. 10.1093/cid/ciq146 - PubMed
    1. Thomas CA, Picone A, Menon S, Willis BC. Empirical vancomycin dosing in Pediatric patients with congenital heart Disease and the impact of cardiopulmonary bypass on trough concentrations. Pharmacotherapy. 2017;37(11):1341–6. 10.1002/phar.2019. 10.1002/phar.2019 - DOI - PubMed
    1. Martin JH, Norris R, Barras M, et al. Therapeutic monitoring of Vancomycin in adult patients: a consensus review of the American Society of Health-System Pharmacists, the Infectious Diseases Society of America, and the society of infectious diseases pharmacists. Clin Biochem Rev. 2010;31(1):21–4. - PMC - PubMed
    1. Hoang J, Dersch-Mills D, Bresee L, Kraft T, Vanderkooi OG. Achieving therapeutic Vancomycin levels in pediatric patients. Can J Hosp Pharm. 2014;67(6):416–22. 10.4212/cjhp.v67i6.1403. 10.4212/cjhp.v67i6.1403 - DOI - PMC - PubMed
    1. Frymoyer A, Hersh AL, Benet LZ, Guglielmo BJ. Current recommended dosing of Vancomycin for children with invasive methicillin-resistant Staphylococcus aureus infections is inadequate. Pediatr Infect Dis J. 2009;28(5):398–402. 10.1097/INF.0b013e3181906e40. 10.1097/INF.0b013e3181906e40 - DOI - PMC - PubMed