Impact of a Hospitalwide Increase in Empiric Pediatric Vancomycin Dosing on Initial Trough Concentrations

• Published in: Pharmacotherapy 2011-09, Vol.31 (9), p.871-876
• Main Authors: Frymoyer, Adam, Guglielmo, B. Joseph, Wilson, Stephen D., Scarpace, Sarah B., Benet, Leslie Z., Hersh, Adam L.
• Format: Article
• Language: English
• Subjects: Anti-Bacterial Agents - administration & dosage; Anti-Bacterial Agents - pharmacokinetics; Anti-Bacterial Agents - therapeutic use; Biological and medical sciences; Child; Child, Preschool; children; Dose-Response Relationship, Drug; Drug Administration Schedule; Female; Humans; Infant; Male; Medical sciences; methicillin-resistant Staphylococcus aureus; Methicillin-Resistant Staphylococcus aureus - drug effects; MRSA; pharmacokinetics; Pharmacology. Drug treatments; Retrospective Studies; Staphylococcal Infections - drug therapy; vancomycin; Vancomycin - administration & dosage; Vancomycin - pharmacokinetics; Vancomycin - therapeutic use
• ISSN: 0277-0008; 1875-9114
• DOI: 10.1592/phco.31.9.871

Study Objective. To evaluate the impact of a hospitalwide increase in the recommended vancomycin starting dose from 45 to 60 mg/kg/day on initial vancomycin trough concentrations in children suspected of having an invasive methicillin‐resistant Staphylococcus aureus (MRSA) infection. Design. Retrospective medical record review. Setting. Dedicated children's hospital located in a tertiary care, academic medical center. Patients. A total of 182 children aged 1 month‐12 years with normal renal function who had suspected MRSA infections treated with vancomycin during two different starting dose recommendation periods: 45 mg/kg/day divided every 8 hours during July 2006‐June 2007 (low‐dose group [88 children]) and 60 mg/kg/day divided every 6 hours during July 2008‐June 2009 (high‐dose group [94 children]). Measurement and Main Results. Data on patient demographics, vancomycin doses, and initial vancomycin trough concentrations were collected. No significant demographic differences were noted between patients in the low‐dose and high‐dose groups. The mean ± SD initial vancomycin trough level increased from 7 ± 5 μg/ml in the low‐dose group to 9 ± 5 μg/ml in the high‐dose group (p