Variation in vancomycin dosing and therapeutic drug monitoring practices in neonatal intensive care units

Background Vancomycin is a frequently used antibiotic in neonates. However, there is no consensus guideline on the optimal dosing regimen and therapeutic drug monitoring (TDM) practices in this patient population. Objective To document the variability in the current dosing and TDM practices in neona...

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Bibliographic Details
Published in:International journal of clinical pharmacy 2022-04, Vol.44 (2), p.564-569
Main Authors: van der Veen, Anouk, Somers, Annemie, Vanhaesebrouck, Sophie, ter Heine, Rob, Brüggemann, Roger, Allegaert, Karel, De Cock, Pieter
Format: Article
Language:English
Subjects:
Analysis
Anti-Bacterial Agents
Antibiotics
Birth weight
Child
Creatinine
Dosage
Drug dosages
Drug Monitoring - methods
Evidence-based medicine
Gestational Age
Health aspects
Humans
Infant, Newborn
Infants (Newborn)
Inflammation
Intensive care
Intensive care units
Intensive Care Units, Neonatal
Internal Medicine
Medicine
Medicine & Public Health
Neonatal intensive care
Neonates
Newborn babies
Nonsteroidal anti-inflammatory drugs
Patient monitoring equipment
Pharmacy
Short Research Report
Surveys
Therapeutic drug monitoring
Vancomycin
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Summary:Background Vancomycin is a frequently used antibiotic in neonates. However, there is no consensus guideline on the optimal dosing regimen and therapeutic drug monitoring (TDM) practices in this patient population. Objective To document the variability in the current dosing and TDM practices in neonatal intensive care units (NICU). Setting Belgian and Dutch NICUs. Method An online questionnaire was disseminated by e-mail to potential respondents. Main outcome measure Differences in vancomycin dosing and TDM practices in comparison with a reference source, the Dutch Paediatric Formulary. Results Eighteen NICUs (response rate 62%) participated. Eleven different dosing regimens are applied, with 83% using intermittent dosing regimens. Stratifying covariates used to determine the (initial) dosage include gestational age, postnatal age, serum creatinine, concurrent use of non-steroidal anti-inflammatory drugs, birth weight and current weight. Large variability is observed with regard to TDM practice as well, both for the concentration target range and the times of (re)sampling. Dosing calculators are more commonly used in the Netherlands than Belgium. Conclusion Significant inter-centre variability in dosing and TDM practices was found. The development of international consensus guidelines is required to optimize therapy. Dosing calculators to guide dosing are not yet considered as part of standard-of-care.
ISSN:2210-7703
2210-7711
DOI:10.1007/s11096-021-01345-9