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Vancomycin therapeutic drug monitoring in paediatrics.
- Source :
-
Journal of paediatrics and child health [J Paediatr Child Health] 2020 Apr; Vol. 56 (4), pp. 563-570. Date of Electronic Publication: 2019 Nov 13. - Publication Year :
- 2020
-
Abstract
- Aim: Vancomycin guidelines for therapeutic drug monitoring (TDM) aim to maximise efficacy while minimising toxicity and resistance. Vancomycin is effective against Staphylococcus aureus when it achieves area under the concentration-time curve (AUC)/minimum inhibitory concentration (MIC) > 400. Studies in children have shown that target trough concentrations poorly correlate to AUC/MIC > 400; however, they are used in practice for clinical convenience. This review in paediatric inpatients aims to audit performance against TDM guidelines and consider what changes are needed to optimise vancomycin monitoring.<br />Methods: Vancomycin prescriptions in patients younger than 18 years old were collected over a 15-month period. Primary outcome measures were vancomycin initial dose (mg/kg/day) and the timing and result of first trough concentration (mg/L). Secondary outcome measures were the numbers achieving recommended targets and whether appropriate dose adjustments were made in response to TDM.<br />Results: A total of 133 courses reached the time when TDM should occur. Average patient age was 6.5 years, and the average initial dose was 52.55 mg/kg/day (range 19.05-86.54 mg/kg). Only 25% of courses (n = 34) had a trough concentration measured at the recommended time. The mean trough concentration was 11.6 mg/L (range < 2.0-39.7). Of 40 patients with a low trough concentration, 50% continued without dose adjustment.<br />Conclusion: As shown in the literature, there is a poor correlation between the vancomycin dose given and the trough concentration achieved. Given that recommendations for trough concentration monitoring are designed to simplify the process yet are poorly adhered to, a strategic plan to address these issues is needed.<br /> (© 2019 Paediatrics and Child Health Division (The Royal Australasian College of Physicians).)
Details
- Language :
- English
- ISSN :
- 1440-1754
- Volume :
- 56
- Issue :
- 4
- Database :
- MEDLINE
- Journal :
- Journal of paediatrics and child health
- Publication Type :
- Academic Journal
- Accession number :
- 31721353
- Full Text :
- https://doi.org/10.1111/jpc.14683