Clinical Pharmacokinetics of Vancomycin in Critically Ill Children

Sridharan, Kannan; Daylami, Amal Al; Ajjawi, Reema; Al-Ajooz, Husain; Veeramuthu, Sindhan

doi:10.1007/s13318-019-00568-6

Cited by 19 publications

(31 citation statements)

References 39 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Review of titles and abstracts led to the retrieval of 215 potentially relevant full‐text citations. After full‐text review, 25 citations met the criteria for inclusion 16–41 . The most common reason for exclusion was non‐pediatric population studies (190 citations), followed by lack of ARC data (24 citations).…”

Section: Resultsmentioning

confidence: 99%

“…Table 1 summarizes the characteristics of the studies included based upon their primary objective 16–41 . The first articles related to ARC in pediatrics were published in 2015 and were pharmacokinetic objective studies 20,36 .…”

Section: Resultsmentioning

confidence: 99%

“…In 2019, the first articles were published that evaluated general information related to ARC in pediatric patients 16,28,34 . Most of the published work (84%) has described the impact of ARC on pharmacokinetic/pharmacodynamic alterations in antimicrobial agents 18–22,24–27,29–33,35–41 . The 25 citations, representing a total of 2102 patients, were published across 22 different journals, with only two journals having more than one published article related to ARC: Pediatric Nephrology and Antimicrobial Agents and Chemotherapy .…”

Section: Resultsmentioning

confidence: 99%

“…Table 4 summarizes the 21 studies that evaluated the impact of ARC on pharmacokinetic and pharmacodynamic parameters 18–22,24–27,29–33,35–41 (see Table for full extraction of pharmacokinetic and pharmacodynamic data). Most of the studies evaluated glycopeptides (42.9%), 22,24,25,30,32,33,36,37,41 followed by aminoglycosides (19%), 21,31,38,40 penicillins (14.3%), 18–20 and carbapenems (9.5%) 27,39 . Cefazolin, 29 colistin, 26 and acyclovir/valacyclovir 35 were evaluated individually in three other publications.…”

Section: Resultsmentioning

confidence: 99%

“…Although some studies noted the need for increased dosing or frequency, only limited information was provided for specific dosing recommendations and minimal reported impact on clinical outcomes. Clinical failure with amoxicillin and piperacillin was described by De Cock et al 20 and Béranger et al, 18 respectively, whereas Sridharan et al 33 reported a trend of increased mortality with lower vancomycin trough concentrations. It is hypothesized that ARC would be related to worse clinical outcomes including an increased risk for antimicrobial resistance 55,57 ; although this has been reported in some adult studies, not all studies confirm this hypothesis 51,58 .…”

Section: Discussionmentioning

confidence: 96%

See 4 more Smart Citations

Scoping review of augmented renal clearance in critically ill pediatric patients

2021

View full text Add to dashboard Cite

Augmented renal clearance (ARC), a phenomenon of enhanced elimination of renal solutes, has been described in adult critically ill patients, but little is known about the phenomenon in children. The aim of this scoping review was to gather and summarize all evidence on ARC in pediatric patients to examine its breadth and depth including prevalence, risk factors, and pharmacokinetic alterations and identify any gaps for further areas of inquiry. PubMed, Embase, and Web of Science were searched for titles, abstracts, or keywords that focused on ARC. Non‐English studies, reviews, and nonhuman studies were excluded. Reporting followed the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses for Scoping Reviews (PRISMA‐ScR) guidelines. Data were extracted on article type, study details, patient population, ARC definition and prevalence, methods of renal function assessment, and study results. A total of 215 citations were found with 25 citations meeting the criteria for inclusion in pediatrics (2102 total patients); the majority of studies (84%) focused on pharmacokinetics (PK) of antimicrobial agents. The median/mean age range was 1.25–12 years. There were a total of 10 different definitions of ARC. The prevalence of ARC ranged from 7.8% to 78%. The most common method for documenting creatinine clearance (CrCl) was the modified Schwartz equation (64%). Only 20% of studies reported risk factors for ARC including low serum creatinine, increasing age, febrile neutropenia, male, septic shock, and treatment with antibiotics. Glycopeptide antimicrobials were the most evaluated class (42.9%) among the 21 antimicrobial drug studies. All studies reported increased drug clearance and/or poor probability of achieving target concentrations of the agents studied. ARC showed variable prevalence in pediatric patients likely due to the lack of a standard definition and many studies not considering age‐related changes in CrCl with pediatric intensive care unit (PICU) patients. ARC was shown to impact PK of antibiotics commonly administered to pediatric patients, which may necessitate changes in standard dosing regimens.

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 96%

See 3 more Smart Citations

Scoping review of augmented renal clearance in critically ill pediatric patients

2021

View full text Add to dashboard Cite

show abstract

Comparison of Vancomycin Clearance Between Augmented Renal Clearance and Normal Renal Function in Critically Ill Infants: A Population Pharmacokinetics Study

Guang-ming

Qiu

Liu

et al. 2022

The Journal of Clinical Pharma

View full text Add to dashboard Cite

Augmented renal clearance presents as super-renal function with enhanced renal perfusion and glomerular hyperfiltration in many critically ill infants. This study was to compare vancomycin clearance (CL) between critically ill infants with augmented renal clearance and with normal renal function and to optimize the vancomycin dosage. Data were retrospectively obtained from infants treated in intensive care units. Population pharmacokinetics analysis was conducted using nonlinear mixed-effects model software. A total of 66 critically ill infants were included: 47 infants with augmented renal clearance and 19 infants with normal renal function. The median doses of vancomycin for infants with augmented renal clearance and with normal renal function were 48 and 47 mg/kg/day (P > .05), respectively. The median CL in infants with augmented renal clearance was increased 1.96-fold compared with infants who had normal renal function (0.98 versus 0.5 L/h, P < .001). Simulations indicated that the recommended dosage of 60, 70, 80, 90, and 100 mg/kg/day would be appropriate in critically ill infants with an estimated glomerular filtration rate (eGFR) of 130-149, 150-169, 170-189, 190-209, and >210 mL/min/1.73 m 2 , respectively. Doses of 70 and 75 mg/kg/day were recommended for infants with augmented renal clearance and gestational ages of 27-32.9 and 33-39 weeks, respectively. Doses of 70, 75, 80, and 90 mg/kg/day were recommended for infants with augmented renal clearance and weights of 2.0-2.9, 3.0-3.9, 4.0-4.9, and 5.0-6.0 kg, respectively. In conclusion, the typical vancomycin dosage is insufficient for critically ill infants with augmented renal clearance. Premature infants and infants of low weight with augmented renal clearance need individualized dosing regimens to obtain an adequate area under the serum concentration time curve over 24 h/minimum inhibitory concentration ratio.

show abstract

The relationship between vancomycin AUC/MIC and trough concentration, age, dose, renal function in Chinese critically ill pediatric patients

Chen

Huang

et al. 2021

Pharmacology Res & Perspec

View full text Add to dashboard Cite

To assess the pharmacokinetic parameters of vancomycin in Chinese critically ill pediatric patients, children treated with vancomycin, hospitalized in the intensive care unit were included. Samples to determine peak and trough serum concentrations were obtained on the third day of treatment. Half‐life was significantly longer in neonates and showed a decreasing trend in infants and children. In patients aged ≥1 month, AUC 24 /MIC ≥400 was achieved in 31.8% at the dose of 40 mg/kg/d, and in 48.7% at the dose of 60 mg/kg/d with an assumed MIC of 1 mg/L. Augmented renal clearance (ARC) was present in 27.3% of children, which was associated with higher vancomycin clearance and lower AUC values. A good correlation was observed between trough concentration and AUC 24 , and the trough concentration that correlated with AUC 24 of 400 were varied according to the dosage regimens, 8.42 mg/L for 6‐hintervals, and 6.63 mg/L for 8‐h intervals. To conclude, vancomycin trough concentration that related to the AUC 24 of 400 was much lower in critically ill children than that in adults. The dosage of 60 mg/kg/day did not enough for producing AUC 24 in the range of 400–600 mg h/L in critically ill children, especially in those with ARC.

show abstract

Clinical Pharmacokinetics of Vancomycin in Critically Ill Children

Cited by 19 publications

References 39 publications

Scoping review of augmented renal clearance in critically ill pediatric patients

Scoping review of augmented renal clearance in critically ill pediatric patients

Comparison of Vancomycin Clearance Between Augmented Renal Clearance and Normal Renal Function in Critically Ill Infants: A Population Pharmacokinetics Study

The relationship between vancomycin AUC/MIC and trough concentration, age, dose, renal function in Chinese critically ill pediatric patients

Contact Info

Product

Resources

About