Effect of Vancomycin Loading Doses on the Attainment of Target Trough Concentrations in Hospitalized Children

Abstract

OBJECTIVE Subtherapeutic vancomycin trough concentrations are common in children and may be associated with suboptimal therapeutic response. Our objective was to determine if vancomycin loading doses safely increase the frequency of target trough attainment in hospitalized children. METHODS Patients (≥6 months and <18-years-old) who received a vancomycin loading dose between February 1, 2018, and January 30, 2019, were retrospectively enrolled. These patients were compared to a convenience cohort of patients hospitalized between January 1, 2015, and December 31, 2015, who received vancomycin without a loading dose. Target trough concentrations were defined as >15 mg/dL for invasive infections and >10 mg/dL for non-invasive infections. RESULTS A total of 151 patients were enrolled, with 77 in the control arm and 74 in the loading dose arm. There was no significant difference in the frequency of comorbidities or need for intensive care unit admission between the two arms. Those receiving a vancomycin loading dose were older (mean age 9.1 vs 5.2 years, p < 0.0001). Patients given a loading dose achieved higher mean initial trough values (13.0 mg/dL vs 9.2 mg/dL, p < 0.0001), were more likely to have an initial trough at or above target (37.0% vs 10.4%, p = 0.0001), were more likely to reach target trough values at any point during therapy (52.1% vs 32.9%, p = 0.0081), and attained a target trough concentration more quickly (mean 41.1 hours vs 58.8 hours, p = 0.0118). There were no significant differences in the frequency of serum creatinine elevation or oliguria at the end of therapy. CONCLUSIONS Vancomycin loading doses may improve the ability to safely obtain target trough values in hospitalized children.

Desenvolvimento De Um Nomograma De Doses De Vancomicina Para Pacientes Pediátricos: Uma Estratégia Para O Uso Racional De Antimicrobianos

“…(6) Além disso, um recente estudo mostrou que as doses de ataque de vancomicina podem melhorar a capacidade de obter com segurança os valores mínimos desejados em crianças hospitalizadas. (15) Por fim, a escolha dos tempos de infusão de acordo com a dose foi estabelecido devido ao perfil de segurança da vancomicina. Sabe-se que a administração rápida de vancomicina (em torno de 30 minutos) pode causar uma reação adversa transitória conhecida como "síndrome do homem vermelho" ou "do pescoço vermelho".…”

Application of User-Centered Codesign Principles to Address Barriers in Therapeutic Drug Monitoring

“…The opportunity to use software to optimize initial dosing should not be ignored, given that vancomycin loading doses are commonly suboptimal in practice. 44–48…”

“…The opportunity to use software to optimize initial dosing should not be ignored, given that vancomycin loading doses are commonly suboptimal in practice. [44][45][46][47][48] A key finding from this study was the need for software to be tailored to the level of confidence and experience of a user. 49,50 For instance, embedded hyperlinks to explanatory resources is a form of passive decision support that can facilitate self-directed learning by inexperienced or less confident users.…”

Recent Advances in Therapeutic Drug Monitoring of Voriconazole, Mycophenolic Acid, and Vancomycin: A Literature Review of Pediatric Studies

“…The application of the loading dose was at the discretion of the clinician. The application of the loading dose improved the achievement of therapeutic concentrations; however, for the majority of patients, after receiving the loading dose, the concentrations were still subtherapeutic [130,150].…”