Vancomycin Dosing in Obese Pediatric Patients

Moffett, Brady S.; Kim, Shelly; Edwards, Morven S.

doi:10.1177/0009922810393500

Cited by 37 publications

(30 citation statements)

References 13 publications

(15 reference statements)

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“…We present one of the largest cohorts published to date evaluating vancomycin, obesity, and nephrotoxicity [13][14][15][16][17][18][19][29][30][31]. Our study observed a 21% incidence of nephrotoxicity (obese = 18% vs. lean = 23%) among infectious episodes treated with vancomycin and a 12% incidence of new-onset hemodialysis (obese = 10% vs. lean = 14%).…”

Section: Discussionmentioning

confidence: 78%

Vancomycin-Associated Nephrotoxicity: The Obesity Factor

Davies

Efird

Guidry

et al. 2015

Surgical Infections

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Section: Discussionmentioning

confidence: 78%

Vancomycin-Associated Nephrotoxicity: The Obesity Factor

Davies

Efird

Guidry

et al. 2015

Surgical Infections

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“…Data suggest dosage regimens be based on TBW, although obese patients may require more vigilant serum-level monitoring. [20][21][22][23] Pediatric studies have also recommended aminoglycoside dosage be based on either TBW or adjusted body weight.…”

Section: The Issuementioning

confidence: 99%

Medication Dosage in Overweight and Obese Children

Matson¹,

Horton²,

Capino³

2017

The Journal of Pediatric Pharmacology and Therapeutics

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Approximately 31.8% of U.S. children ages 2 to 19 years are considered overweight or obese. This creates significant challenges to dosing medications that are primarily weight based (mg/kg) and in predicting pharmacokinetics parameters in pediatric patients. Obese individuals generally have a larger volume of distribution for lipophilic medications. Conversely, the Vd of hydrophilic medications may be increased or decreased due to increased lean body mass, blood volume, and decrease percentage of total body water. They may also experience decreased hepatic clearance secondary to fatty infiltrates of the liver. Hence, obesity may affect loading dose, dosage interval, plasma half-life, and time to reach steady-state concentration for various medications. Weight-based dosing is also a cause for potential medication errors. This position statement of the Pediatric Pharmacy Advocacy Group recommends that weight-based dosing should be used in patients ages < 18 years who are < 40 kg; weight-based dosing should be used in patients ≥ 40 kg, unless, unless the recommended adult dose for the specific indication is exceeded; clinicians should use pharmacokinetic analysis for adjusting medications in overweight/obese children; and research efforts continue to evaluate dosing of medications in obese/overweight children.

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“…2–7 In obese adults, weight-adjusted V d was decreased, whereas weight-adjusted CL was either similar or decreased. 4–7 Pediatric studies did not yield significant conclusions regarding differences in weight-adjusted V d and CL.…”

Section: Introductionmentioning

confidence: 99%

“…4–7 Pediatric studies did not yield significant conclusions regarding differences in weight-adjusted V d and CL. 2,3,8,9 Notably, none of these pediatric PK studies used Bayesian analysis, which is better in predicting V d and CL in an obese population based on an understanding of the population PK properties and interindividual and intra-individual variability.…”

Section: Introductionmentioning

confidence: 99%

Bayesian Estimation of Vancomycin Pharmacokinetics in Obese Children: Matched Case-Control Study

Lê

Capparelli

Wahid

et al. 2015

Clinical Therapeutics

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Purpose The study objective was to compare different body size descriptors that best estimate vancomycin Vd and clearance (CL). Methods Patients between 3 months and 21 years old who received vancomycin for ≥48 hours from 2003 to 2011 were evaluated in this matched case-control study. Cases had body mass index in the ≥85th percentile; controls were nonobese individuals who were matched by age and baseline serum creatinine (SCr). Using a 1-compartment model with first-order kinetics, Bayesian post hoc individual Vd and CL were estimated. Findings Analysis included 87 matched pairs with 389 vancomycin serum concentrations. Median ages were 10.0 (interquartile range [IQR], 4.8–15.2) years for cases (overweight and obese children) and 10.2 (IQR, 4.5–14.8) years for controls (normal-weight children). Median weights were 44.0 (IQR, 23.4–78.1) kg for cases and 31.3 (IQR, 16.8–47.1) kg for controls. Mean (SD) for the baseline SCr values were also similar between the groups: 0.51 (0.22) (IQR, 0.34–0.67) mg/dL and 0.48 (0.20) (IQR, 0.30–0.60) mg/dL for the cases and controls, respectively. Actual weight and allometric weight (ie, weight0.75) were used in the final model to estimate Vd and CL, respectively. The mean Vd and CL, based on weight, for cases were lower than controls by 0.012 L/kg and 0.014 L/kg/h, respectively. Implications In obese children, actual weight and allometric weight are reasonable, convenient estimations of body fat to use for estimating vancomycin Vd and CL, respectively. However, these pharmacokinetic differences between obese children and those with normal weights are small and may not likely to be clinically relevant in dose variation.

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Vancomycin Dosing in Obese Pediatric Patients

Cited by 37 publications

References 13 publications

Vancomycin-Associated Nephrotoxicity: The Obesity Factor

Vancomycin-Associated Nephrotoxicity: The Obesity Factor

Medication Dosage in Overweight and Obese Children

Bayesian Estimation of Vancomycin Pharmacokinetics in Obese Children: Matched Case-Control Study

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