Unanswered Questions Regarding Optimal Pediatric Vancomycin Use

Sammons, Helen; Starkey, Elizabeth; Constance, Jonathan E.; Sherwin, Catherine M.T.

doi:10.1097/ftd.0000000000000289

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“…This editorial illustrates that appropriate dose adjustments in neonates need to account for maturation processes, which may affect not just pharmacokinetic parameters such as clearance but also protein binding of drugs. Due to maturational changes in vancomycin protein binding and as previously mentioned by other authors, 8,9 it is not reasonable to assume a similar AUC 24 /MIC target level for vancomycin dosing optimization in neonates and adults. As a consequence, we have to be aware that the higher unbound vancomycin fraction in neonates will impact the dose.…”

Section: Discussionmentioning

confidence: 99%

Maturational changes in vancomycin protein binding affect vancomycin dosing in neonates

Leroux

Anker

Smits

et al. 2019

Brit J Clinical Pharma

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Section: Discussionmentioning

confidence: 99%

Maturational changes in vancomycin protein binding affect vancomycin dosing in neonates

Leroux

Anker

Smits

et al. 2019

Brit J Clinical Pharma

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Precision dosing of vancomycin: in defence of AUC-guided therapy in children

Murphy

Girdwood

Goldman

et al. 2021

Journal of Antimicrobial Chemotherapy

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In 2020, new vancomycin guidelines were released, recommending the transition from trough-based to AUC24 monitoring for adult and paediatric patients. Given the resources required to achieve this transition, there has been debate about the costs and benefits of AUC24-based monitoring. A recent narrative review of vancomycin therapeutic drug monitoring in paediatrics claims to have uncovered the methodological weaknesses of the data that informed the guidelines and advises against premature adoption of AUC24-guided monitoring. In this article, we present supporting arguments for AUC24-guided monitoring in children, which include that: (i) troughs alone are inadequate surrogates for AUC24; (ii) vancomycin-associated nephrotoxicity has significant consequences that warrant optimization of dosing; (iii) a substantial portion of children receiving vancomycin are at high risk for poor outcomes and deserve targeted monitoring; and (iv) limited efficacy data in support of AUC24 is not a justification to revert to a less supported monitoring approach.

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Unanswered Questions Regarding Optimal Pediatric Vancomycin Use

Cited by 2 publications

References 9 publications

Maturational changes in vancomycin protein binding affect vancomycin dosing in neonates

Maturational changes in vancomycin protein binding affect vancomycin dosing in neonates

Precision dosing of vancomycin: in defence of AUC-guided therapy in children

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