Am J Perinatol 2015; 32(01): 083-086
DOI: 10.1055/s-0034-1376183
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Optimization of Vancomycin Dosing in Very Low-Birth-Weight Preterm Neonates

Theresa Madigan
1   Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota
,
Christine B. Teng
2   Division of Pediatric Infectious Diseases, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota
3   Department of Pharmacy, National University of Singapore, Novena, Singapore
,
Jena Koshaish
4   Department of Pharmacy, All Children's Hospital, St. Petersburg, Florida
,
Kent R. Johnson
5   Pharmacy Services, Mayo Clinic, Rochester, Minnesota
,
Kevin K. Graner
5   Pharmacy Services, Mayo Clinic, Rochester, Minnesota
,
Ritu Banerjee
2   Division of Pediatric Infectious Diseases, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota
› Author Affiliations
Further Information

Publication History

21 February 2014

28 March 2014

Publication Date:
16 May 2014 (online)

Abstract

Objective To compare vancomycin serum trough concentrations and 24-hour area under the serum concentration-versus-time curve (AUC24) among very low-birth-weight (VLBW) premature infants before and after implementation of an institution-wide increase in neonatal vancomycin dosing.

Study Design We performed a retrospective analysis of vancomycin concentrations among preterm VLBW neonates before (2007–2010) and after (2010–2013) implementation of a new vancomycin dosing protocol consisting of increased vancomycin daily dose and frequency of administration.

Results Neonates weighing < 1,500 g and receiving the new vancomycin dosing regimen had lower rates of undetectable trough concentrations (24 vs. 50%, p = 0.04), higher median trough concentrations (10.8 vs. 5.9 µg/mL, p = 0.003), a higher proportion of goal trough concentrations of 10 to 20 µg/mL (35 vs. 4%, p = 0.005), and a significantly higher vancomycin AUC24 (438 vs. 320 mg·h/L, p = 0.004) compared with historical controls.

Conclusion Increasing the vancomycin daily dose and dosing frequency led to an increase in vancomycin trough concentrations and AUC24, and a decrease in the proportion of undetectable (< 5.0 µg/mL) troughs, without an increase in toxicity among VLBW premature neonates.

 
  • References

  • 1 Stoll BJ, Hansen N, Fanaroff AA , et al. Late-onset sepsis in very low birth weight neonates: the experience of the NICHD Neonatal Research Network. Pediatrics 2002; 110 (2, Pt 1) 285-291
  • 2 de Hoog M, Mouton JW, van den Anker JN. Vancomycin: pharmacokinetics and administration regimens in neonates. Clin Pharmacokinet 2004; 43 (7) 417-440
  • 3 Pacifici GM, Allegaert K. Clinical pharmacokinetics of vancomycin in the neonate: a review. Clinics (Sao Paulo) 2012; 67 (7) 831-837
  • 4 Capparelli EV, Lane JR, Romanowski GL , et al. The influences of renal function and maturation on vancomycin elimination in newborns and infants. J Clin Pharmacol 2001; 41 (9) 927-934
  • 5 Grimsley C, Thomson AH. Pharmacokinetics and dose requirements of vancomycin in neonates. Arch Dis Child Fetal Neonatal Ed 1999; 81 (3) F221-F227
  • 6 Silva R, Reis E, Bispo MA , et al. The kinetic profile of vancomycin in neonates. J Pharm Pharmacol 1998; 50 (11) 1255-1260
  • 7 Liu C, Bayer A, Cosgrove SE , et al; Infectious Diseases Society of America. Clinical practice guidelines by the Infectious Diseases Society of America for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children. Clin Infect Dis 2011; 52 (3) e18-e55
  • 8 Rybak MJ, Lomaestro BM, Rotschafer JC , et al. Therapeutic monitoring of vancomycin in adults summary of consensus recommendations from the American Society of Health-System Pharmacists, the Infectious Diseases Society of America, and the Society of Infectious Diseases Pharmacists. Pharmacotherapy 2009; 29 (11) 1275-1279
  • 9 Frymoyer A, Guglielmo BJ, Hersh AL. Desired vancomycin trough serum concentration for treating invasive methicillin-resistant Staphylococcal infections. Pediatr Infect Dis J 2013; 32 (10) 1077-1079
  • 10 Croes S, Stolk LM. Vancomycin therapeutic guidelines: closer examination of neonatal pharmacokinetics. Clin Infect Dis 2011; 53 (9) 966-967
  • 11 Anderson BJ, Allegaert K, Van den Anker JN, Cossey V, Holford NH. Vancomycin pharmacokinetics in preterm neonates and the prediction of adult clearance. Br J Clin Pharmacol 2007; 63 (1) 75-84
  • 12 Plan O, Cambonie G, Barbotte E , et al. Continuous-infusion vancomycin therapy for preterm neonates with suspected or documented Gram-positive infections: a new dosage schedule. Arch Dis Child Fetal Neonatal Ed 2008; 93 (6) F418-F421
  • 13 Pawlotsky F, Thomas A, Kergueris MF, Debillon T, Roze JC. Constant rate infusion of vancomycin in premature neonates: a new dosage schedule. Br J Clin Pharmacol 1998; 46 (2) 163-167
  • 14 Vella-Brincat JW, Begg EJ, Robertshawe BJ, Lynn AM, Borrie TL, Darlow BA. Are gentamicin and/or vancomycin associated with ototoxicity in the neonate? A retrospective audit. Neonatology 2011; 100 (2) 186-193
  • 15 de Hoog M, van Zanten BA, Hop WC, Overbosch E, Weisglas-Kuperus N, van den Anker JN. Newborn hearing screening: tobramycin and vancomycin are not risk factors for hearing loss. J Pediatr 2003; 142 (1) 41-46