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Korean J Pediatr 2010 December;53(12) :1000-1005.
Therapeutic monitoring of vancomycin according to initial dosing regimen in pediatric patients
Dae Il Kim (Kim DI), Mi Sun Im (Im MS), Jin Hyoung Choi (Choi JH), Jina Lee (Lee Jn), Eun Hwa Choi (Choi EH), Hoan Jong Lee (Lee HJ)
Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
Corresponding Author: Eun Hwa Choi ,Email:
Copyright © 2010 by The Korean Pediatric Society
Purpose : This study aimed to determine the optimal initial vancomycin dose to achieve appropriate trough levels in pediatric patients. Methods : We analyzed clinical data for 309 children treated with intravenous vancomycin between 2004 and 2009 at 2 different hospitals in South Korea. The patients were 1-16 years old and exhibited normal renal function. Patient data, including reason for treatment and initial dosing regimen, were reviewed. Two subgroups were identified and compared according to initial vancomycin dose: 40 (35-45) mg/kg/day and 60 (55-65) mg/kg/day. Trough levels were obtained at steady state after at least 4 doses of vancomycin. Results : Patients who received vancomycin had post-operation or wound-related infections (37.2%), localized infection (12.9%), catheterrelated infections (9.4%), meningitis (8.7%), or endocarditis (6.8%). Pathogens were confirmed in 79 cases: 28 cases of methicillinresistant Staphylococcus epidermidis (35.4%) and 25 of methicillinresistant Staphylococcus aureus (31.6%). Out of the 309 patients, 201 (65%) received vancomycin at 40 mg/kg/day and 108 (35%) at 60 mg/kg/day. Average trough concentrations were significantly different between the groups (P<0.001). Trough levels over 10 mg/L were less likely to be achieved in the 40 mg/kg/day group (14%) than in the 60 mg/kg/day group (49%) (P<0.001). There were no differences in renal function deterioration between the groups. Conclusion : A common vancomycin dosing regimen, 40 mg/kg/ day, was not high enough to achieve trough levels of over 10 mg/L in pediatric patients. Careful drug monitoring must be performed, and increasing initial dose of vancomycin should be considered in pediatric patients.
Keywords: Vancomycin | Drug monitoring | Child
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