Vancomycin serum concentrations in pediatric oncologic/hematologic intensive care patients

Silva, Dáfne Cardoso Bourguignon da; Seixas, Glaucia T. F.; Araújo, Orlei Ribeiro de; Arduini, Rodrigo Genaro; Carlesse, Fabianne; Petrilli, Antônio Sérgio

doi:10.1016/j.bjid.2012.06.011

Cited by 35 publications

(34 citation statements)

References 17 publications

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“…A total of 17 studies reporting PK-parameters of vancomycin in critically ill children were identified by the search, with more than 1000 PICU patients included in total over the whole pediatric age range [41][42][43][44][45][46][47][48][49][50][51][52][53][54][55][56][57]. Most studies included a mixed population, but also specific populations (such as patients with hematologic/oncologic [43,45], cardiac [51,53,56,57], traumatic [50] and infectious diseases [44,48]) being studied separately. Four studies [42,43,46,48] were prospective PK studies and the remaining 13 studies were based on TDM data.…”

Section: Vancomycinmentioning

confidence: 99%

“…Most studies used intermittent dosing with daily doses of vancomycin ranging from 30 to 60 mg/kg/day, with only 1 study reporting higher mean doses (81 mg/kg/day) [45] and 1 study not mentioning the dose at all [41]. Two studies reported data on continuous dosing schedules, using a loading dose of 15 mg/kg and a maintenance dose of 40-45 mg/ kg over 24 h [42,55].…”

Section: Vancomycinmentioning

confidence: 99%

“…Cmin measurements are mainly used for TDM as a surrogate parameter of the true PD target of vancomycin used in adults (AUC/MIC > 400) and is commonly extrapolated to pediatric patients. Several studies determined, simulated or estimated AUC/MIC in their analysis [42,43,45,46,54,55,57]. Giachetto et al reported vancomycin AUC 0-24h / MIC on both day 1, using an initial dose of 33-45 mg/kg/ day, and after TDM on day 3 for MICs of 1 and 2 mg/l [46].…”

Section: Vancomycinmentioning

confidence: 99%

See 2 more Smart Citations

Pharmacokinetics and Target Attainment of Antibiotics in Critically Ill Children: A Systematic Review of Current Literature

et al. 2019

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Background Pharmacokinetics (PK) are severely altered in critically ill patients due to changes in volume of distribution (Vd) and/or drug clearance (Cl). This affects the target attainment of antibiotics in critically ill children. We aimed to identify gaps in current knowledge and to compare published PK parameters and target attainment of antibiotics in critically ill children to healthy children and critically ill adults. Methods Systematic literature search in PubMed, EMBASE and Web of Science. Articles were labelled as relevant when they included information on PK of antibiotics in critically ill, non-neonatal, pediatric patients. Extracted PK-parameters included Vd, Cl, (trough) concentrations, AUC, probability of target attainment, and elimination half-life. Results 50 relevant articles were identified. Studies focusing on vancomycin were most prevalent (17/50). Other studies included data on penicillins, cephalosporins, carbapenems and aminoglycosides, but data on ceftriaxone, ceftazidime, penicillin and metronidazole could not be found. Critically ill children generally show a higher Cl and larger Vd than healthy children and critically ill adults. Reduced target-attainment was described in critically ill children for multiple antibiotics, including amoxicillin, piperacillin, cefotaxime, vancomycin, gentamicin, teicoplanin, amikacin and daptomycin. 38/50 articles included information on both Vd and Cl, but a dosing advice was given in only 22 articles. Conclusion The majority of studies focus on agents where TDM is applied, while other antibiotics lack data altogether. The larger Vd and higher Cl in critically ill children might warrant a higher dose or extended infusions of antibiotics in this patient population to increase target-attainment. Studies frequently fail to provide a dosing advice for this patient population, even if the necessary information is available. Our study shows gaps in current knowledge and encourages future researchers to provide dosing advice for special populations whenever possible.

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Section: Vancomycinmentioning

confidence: 99%

Section: Vancomycinmentioning

confidence: 99%

Section: Vancomycinmentioning

confidence: 99%

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Pharmacokinetics and Target Attainment of Antibiotics in Critically Ill Children: A Systematic Review of Current Literature

et al. 2019

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“…Since current practice relies on trough-only monitoring, the Bayesian approach would be a more conducive option. Other advantages include the program's ability to account for changes in PK profiles and reduce the risk of trough concentrations [20 lg/mL [8,10]. Several validated software programs with Bayesian analysis capabilities such as BestDose TM , MwPharm Ó , and T.D.M.S 2000 TM are available to clinicians, and are currently being used clinically for therapeutic drug monitoring purposes [11].…”

Section: Pediatric Vancomycin Efficacy: How Should Wementioning

confidence: 99%

“…With standard dosing of 40-60 mg/kg/day, the achievement rate decreased to 50 %. Patients were observed to have increased vancomycin clearance and increased volume of distribution, suggesting that pediatric oncology patients with normal renal function need higher vancomycin dosing to achieve the target AUC/MIC compared with otherwise healthy children [10]. Other populations to consider examining for altered vancomycin PK are critically ill, burn, and cardiac patients.…”

Section: Vancomycin Use: Differences In Special Populationsmentioning

confidence: 99%

Balancing Vancomycin Efficacy and Nephrotoxicity: Should We Be Aiming for Trough or AUC/MIC?

2015

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Sixty years later, the question that still remains is how to appropriately utilize vancomycin in the pediatric population. The Infectious Diseases Society of America published guidelines in 2011 that provide guidance for dosing and monitoring of vancomycin in adults and pediatrics. However, goal vancomycin trough concentrations of 15-20 μg/mL for invasive infections caused by methicillin-resistant Staphylococcus aureus were based primarily on adult pharmacokinetic and pharmacodynamic data that achieved an area under the curve to minimum inhibitory concentration ratio (AUC/MIC) of ≥400. Recent pediatric literature shows that vancomycin trough concentrations needed to achieve the target AUC/MIC are different than the adult goal troughs cited in the guidelines. This paper addresses several thoughts, including the role of vancomycin AUC/MIC in dosing strategies and safety monitoring, consistency in laboratory reporting, and future directions for calculating AUC/MIC in pediatrics.

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Individualized Pharmacokinetic Dosing of Vancomycin Reduces Time to Therapeutic Trough Concentrations in Critically Ill Patients

Truong

Smith

Veillette

et al. 2018

The Journal of Clinical Pharma

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Dosing vancomycin in critically ill patients often results in subtherapeutic and supratherapeutic trough concentrations. In this retrospective study, we compared the time to goal trough attainment and incidence of acute kidney injury in intensive care unit (ICU) patients whose vancomycin was dosed by a pharmacy pharmacokinetic (PK) dosing and monitoring service to the standard of care. Three-hundred fifty adult ICU patients at a Level 1 trauma, teaching hospital who received vancomycin for >24 hours from February 1, 2016, to November 30, 2016, were screened. Patients were included in the PK group if consecutive serum concentrations were used to calculate individualized PK and determine a dosing regimen. Patients who were dosed using troughs only were then matched 1-to-1 to the PK group by date of vancomycin initiation and included in the traditional group. Fifty patients were included in each group. Baseline characteristics were similar, except the PK group had more patients under the care of the neuromedical ICU service (42% vs 18%; P = .02) and fewer patients with a corrected creatinine clearance <30 mL/min/1.73 m (22% vs 46%; P = .02). Attainment of goal trough concentrations for the PK and traditional groups were 84.4% and 29.4% by 48 hours (P = .0001), 88.4% and 60.7% by 72 hours (P = .009), and 92.9% and 77.8% by 96 hours (P = .1), respectively. Incidence of acute kidney injury between the PK and traditional groups was not statistically significant (8.3% vs 14%; P = .5). Utilization of individualized pharmacokinetic dosing of vancomycin in critically ill patients resulted in faster goal trough attainment without an increase in nephrotoxicity.

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Vancomycin serum concentrations in pediatric oncologic/hematologic intensive care patients

Cited by 35 publications

References 17 publications

Pharmacokinetics and Target Attainment of Antibiotics in Critically Ill Children: A Systematic Review of Current Literature

Pharmacokinetics and Target Attainment of Antibiotics in Critically Ill Children: A Systematic Review of Current Literature

Balancing Vancomycin Efficacy and Nephrotoxicity: Should We Be Aiming for Trough or AUC/MIC?

Individualized Pharmacokinetic Dosing of Vancomycin Reduces Time to Therapeutic Trough Concentrations in Critically Ill Patients

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