Vancomycin Dosing in Pediatric Extracorporeal Membrane Oxygenation: Potential Impacts of New Technologies

Lonabaugh, Kevin P; Lunsford, Kelly; Fang, Gary; Kaufman, David; Addison, Samuel D.; Buck, Marcia L.

doi:10.5863/1551-6776-22.5.358

Cited by 5 publications

(5 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Several publications about pharmacokinetics of vancomycin and pediatric patients on ECMO support, with different designs and conclusions are available. In a retrospective study, Lonabaugh et al proposed lower dosing than our results, 30 mg/kg/day every 12 h for patients with normal renal function (Lonabaugh et al, 2017). We found similar results for both PK parameters than a retrospective study by Moffett et al, nevertheless we better characterized the drug distribution phase, but they proposed lower doses than ours (Moffett et al, 2018).…”

Section: Discussionsupporting

confidence: 73%

Population Pharmacokinetics of Vancomycin and Meropenem in Pediatric Extracorporeal Membrane Oxygenation Support

et al. 2021

View full text Add to dashboard Cite

Objective: Describe primary pharmacokinetic/pharmacodynamic (PK/PD) parameters of vancomycin and meropenem in pediatric patients undergoing ECMO and analyze utilized dosing to reach PK/PD target.Design: Prospective, multicentric, population PK analysis.Setting: Two hospitals with pediatric intensive care unit.Patients: Pediatric patients (1 month - 15 years old) receiving vancomycin and meropenem for empiric or definitive infection treatment while ECMO support.Measurements and Main Results: Four serum concentration were obtained for patients receiving vancomycin (n = 9) and three for meropenem (n = 9). The PK/PD target for vancomycin was a ratio of the area under the curve to the minimal inhibitory concentration (AUC/MIC) of >400, and for meropenem was 4 times above MIC for 50% of the dosing interval (fT50% > 4xMIC). Pharmacokinetic modeling was performed using PMetrics 1.5.0. We included nine patients, with 11 PK profiles for each antimicrobial. The median age of patients was 4 years old (2 months - 13 years) and 45% were male. Creatinine clearance (CL) was 183 (30–550) ml/min/1.73 m2. The median dose was 13.6 (range 10–15) mg/kg every 6–12 h and 40 mg/kg every 8–12 h for vancomycin and meropenem, respectively. Two compartment models were fitted. Weight was included as a covariate on volume of the central compartment (Vc) for meropenem. Weight was included as a covariate on both Vc and clearance (CL) and serum creatinine was also included as a covariate on CL for vancomycin. The pharmacokinetic parameters CL and Vc were 0.139 ± 0.102 L/h/kg and 0.289 ± 0.295 L/kg for meropenem and 0.060 ± 0.055 L/h/kg and 0.419 ± 0.280 L/kg for vancomycin, respectively. Across each dosing interval 91% of patients achieved the PK/PD targets for adequate exposure for meropenem and 63.6% for vancomycin.Conclusion: Pharmacokinetic/pharmacodynamic objectives for vancomycin were achieved partially with conventional doses and higher dosing with extended infusion were needed in the case of meropenem.

show abstract

Section: Discussionsupporting

confidence: 73%

Population Pharmacokinetics of Vancomycin and Meropenem in Pediatric Extracorporeal Membrane Oxygenation Support

et al. 2021

View full text Add to dashboard Cite

show abstract

“…In pediatric patients, a trough concentration of vancomycin of 8-15 mg/dL is considered therapeutic. [16] In the present study, the trough concentration was 10-20 mg/L. New Chinese guidelines have suggested that steady-state concentrations should be maintained at 10-20 mg/L in adult patients with serious MRSA infections.…”

Section: Discussionmentioning

confidence: 46%

“…Therefore, new guidelines aimed at higher vancomycin serum concentrations should be carefully considered. In pediatric patients, a trough concentration of vancomycin of 8–15 mg/dL is considered therapeutic [16] . In the present study, the trough concentration was 10–20 mg/L.…”

Section: Discussionmentioning

confidence: 61%

Target serum concentration of vancomycin may be reached earlier with a loading dose

Huang

Deng

et al. 2022

Chinese Medical Journal

View full text Add to dashboard Cite

Background:Vancomycin treatment failure against vancomycin-susceptible gram-positive cocci is not rare in the intensive care unit (ICU). One of the reasons for this is the substandard drug trough concentration. We aimed to examine the hypothesis that the target serum concentration could be reached earlier with a loading dose of vancomycin.Methods:This retrospective cohort study was conducted at our ICU between June 2018 and June 2020 and involved patients who were suspected of having, or confirmed to have, gram-positive cocci infection and treated with vancomycin. One group of the patients was administered a loading dose of vancomycin (loading group) and compared with the group that did not receive a loading dose (control group). The baseline characteristics, vancomycin serum concentrations, and clinical outcomes were collected and analyzed.Results:Fifty-five patients were finally included, of which 29 received a loading dose of vancomycin. The serum concentration of vancomycin before the second dose was significantly higher for the loading group than for the control group (10.3 ± 6.1 mg/L vs. 5.7 ± 4.4 mg/L, P = 0.002). The results for both groups were similar before the fifth dose (12.4 ± 7.3 mg/L vs. 10.3 ± 6.3 mg/L in the loading and the control groups, respectively; P = 0.251). The 28-day mortality was lower for the loading group than for the control group (6.7% vs. 34.6% in the loading and control groups, respectively; P = 0.026). No significant differences were observed in serum creatinine (Cr) concentrations of the two groups.Conclusion:With the loading dose of vancomycin, the target serum concentration of vancomycin may be reached earlier without increasing the risk of acute kidney injury.Trial registration:https://www.chictr.org.cn; ChiCTR2000035369

show abstract

“…Therefore, implementing new guidelines aiming at higher vancomycin serum concentrations should be carefully considered. In pediatric patients, the trough range of vancomycin of 8-15 mg/dL is considered to be therapeutic [8] . In the present study, the trough concentration was 10-20 mg/L.…”

Section: Discussionmentioning

confidence: 99%

Earlier Targeted Vancomycin Troughs Concentration with Loading Dose: A Retrospective Study

Huang

Deng

et al. 2021

Preprint

View full text Add to dashboard Cite

Background: Studies have shown the failure of vancomycin treatment against vancomycin-sensitive gram-positive bacteria is common, possibly because the drug concentration did not reach the target serum concentration in time. In this study, we conducted a retrospective analysis to determine whether the target serum concentration could be reached earlier with the first loading dose of vancomycin.Methods: A retrospective single-center study was conducted in the Department of Critical Care Medicine, Ruijin Hospital North Affiliated to Shanghai Jiao Tong University School of Medicine between June 2018 and June 2020. The study enrolled patients who were suspected or confirmed with gram-positive bacterial infection and had been treated with vancomycin. According to whether the first loading dose of vancomycin was given, the patients were divided into the loading dose and the control groups. The serum concentration of vancomycin before the second dose and that before the fifth dose were compared to determine whether the target serum concentration was reached earlier with the first loading dose. And renal functions were monitored for a week to analyze whether the loading dose caused any acute kidney injury.Results: 55 patients were finally included in the study. Of these patients, 29 received first-loading dose of vancomycin, while the remaining 26 patients underwent the traditional dose regimen of vancomycin. The concentration of vancomycin before the second dose was 10.3±6.1 mg/L in the loading group, and 5.7±4.4 mg/L in the control group, significantly higher in the former group (P=0.002). The concentration of vancomycin before the fifth dose was 12.4±7.3 mg/L in the loading group, and 10.3±6.3 mg/L in the control group, where there was no inter-group difference (P=0.251). The 28-day motality of loading dose group is significantly lower (6.7% vs 34%, P=0.026) than the control group. There were no significant changes in serum creatinine levels in both groups, and there was no statistical difference in serum creatinine levels between the two groups.Conclusions: With the loading dose of vancomycin, the target serum concentration of vancomycin could be reached earlier without causing acute kidney injuries, also the mortality might be reduced.

show abstract

Vancomycin Dosing in Pediatric Extracorporeal Membrane Oxygenation: Potential Impacts of New Technologies

Cited by 5 publications

References 15 publications

Population Pharmacokinetics of Vancomycin and Meropenem in Pediatric Extracorporeal Membrane Oxygenation Support

Population Pharmacokinetics of Vancomycin and Meropenem in Pediatric Extracorporeal Membrane Oxygenation Support

Target serum concentration of vancomycin may be reached earlier with a loading dose

Earlier Targeted Vancomycin Troughs Concentration with Loading Dose: A Retrospective Study

Contact Info

Product

Resources

About