Multiple dose activated charcoal as treatment of vancomycin toxicity in premature neonates

Background: Supratherapeutic vancomycin infusions of 300-400 mg/kg were inadvertently administered to three premature neonates (AR, DH, SP). Reported beta-elimination half-life (T1/2) of normal dosing of vancomycin in neonates is 13.4-33.7 hours (hr). A T1/2 of 35 hr was reported in an iatrogenically-overdosed premature neonate. Multiple dose activated charcoal (MDAC) was given to enhance elimination in our 3 patients. Case Series: Following vancomycin infusion, three neonates developed apnea, hypotension, flushed skin, and inflamed infusion, sites. Initial vancomycin levels were: AR--287.7 mcg/mL (wt 3120 g), DH--371.4 mcg/mL (wt 690g), and SP--357.2 mcg/mL (wt 1275g). MDAC (1 g/kg every 4 hours) was given for 24 hours to patient AR and 48 hours to patients DH and SP. TI/2 for vancomycin pre- and post-MDAC (see Table). Conclusions: MDAC reduced the beta-T 1/2 of vancomycin in 2 of 3 preterm neonates. T1/2 in the 3rd neonate during MDAC was less than previously reported in neonatal overdose. T1/2 reduction was greatest in AR who received the highest mg/kg dose of AC. MDAC should be considered for treatment of vancomycin toxicity. Patient T 1/2 pre-MDAC T 1/2 during MDAC AR 5.3 hours (during therapeutic dosing) 1.9 hours DH 14 hours (following overdose) 7.3 hours SP 5.3 hours (during therapeutic dosing) 5.2 hours Abstract 204. Barker K (1), Ford M (2), Wright K (3), Seger D (1). (1) Vanderbilt University Medical Center, Nashville TN, (2) Carolinas Medical Center, Charlotte NC, (3) University of Tennessee Medical Center, Knoxville TN
Barker K (1), Ford M (2), Wright K (3), Seger D (1). (1) Vanderbilt University Medical Center, Nashville TN, (2) Carolinas Medical Center, Charlotte NC, (3) University of Tennessee Medical [...]