Children may need higher vancomycin doses to achieve therapeutic levels.

• Published in: Acta Paediatrica
• Main Authors: Oskarsdottir, Kristin, Haraldsson, Asgeir, Thorkelsson, Thordur, Oskarsdottir, Thorunn, Gunnarsson, Petur, Thors, Valtyr
• Other Authors: 1Faculty of Medicine, University of Iceland, Reykjavik, Iceland. 2Children's Hospital Iceland, Landspitali University Hospital, Reykjavik, Iceland. 3Pharmacy department, Landspitali University Hospital, Reykjavik, Iceland. 4Faculty of Pharmaceutical Sciences, University of Iceland, Reykjavik, Iceland.
• Format: Article in Journal/Newspaper
• Language: English
• Published: Wiley 2021
• Subjects: children; empiric treatment; malignancy; therapeutic drug monitoring; vancomycin; Börn; Krabbamein; Lyfjagjöf; Iceland
• Online Access: http://hdl.handle.net/2336/621943; https://doi.org/10.1111/apa.16025

To access publisher's full text version of this article click on the hyperlink below Aim: Vancomycin is frequently used in paediatric hospitals. Data suggest trough levels of 10-20 mg/L are needed to achieve bacterial killing. This study aimed to evaluate if commonly used dosing regimens are efficient in reaching these levels and if therapeutic drug monitoring (TDM) was appropriately used. Methods: All children receiving intravenous vancomycin at the Children´s Hospital Iceland between 2012 and 2016 were included. Vancomycin trough levels were registered. Student t test, Wilcoxon test and regression models were used for statistical analysis. Results: A total of 105 children received 163 vancomycin treatments (55/105 neonates). Average daily dose in neonates was 23.4 mg/kg/day and 38.4 mg/kg/day for older children. No TDM was done in 58 treatments (35.6%). First trough levels were <10mg/L in 52.4% and <15mg/L in 92% of cases. Therapeutic levels were less likely achieved in children with malignancy (11.8%) compared with others (36.8%, p = 0.09). Conclusions: In more than half of the cases, trough drug levels were <10 mg/L and malignancy was associated with the lowest probability of reaching therapeutic levels. This study suggests that starting doses of vancomycin in children should be higher, especially in relation to malignant diseases and supports the importance of antibiotic stewardship to ensure optimal antibiotic use. Keywords: children; empiric treatment; malignancy; therapeutic drug monitoring; vancomycin.