Durham Spencer H, Simmons Marroyln L, Mulherin Diana W, Foland Jason A
Auburn University Harrison School of Pharmacy, Auburn, Alabama;
St. Joseph's Children's Hospital, Tampa, Florida;
Hosp Pediatr. 2015 May;5(5):276-81. doi: 10.1542/hpeds.2014-0081.
To determine the incidence with which a vancomycin dosing regimen of 15 mg/kg per dose every 6 hours achieves steady-state trough concentrations of 15 to 20 mg/L in pediatric patients with complicated infections.
We performed a retrospective chart review for patients admitted to our children's hospital between July 1, 2009, and June 30, 2011. Patients were included if they were between 1 month and 18 years of age, had at least 1 steady-state vancomycin trough obtained, received an initial vancomycin dose of 15 mg/kg per dose every 6 hours, and were being treated for a diagnosis of meningitis, pneumonia, osteomyelitis, bacteremia/sepsis, or endocarditis.
Seventy-four patients were enrolled, mean age of 4.2±3.9 years and weight of 17.0±11.2 kg. Five (6.8%) patients obtained an initial trough of 15 to 20 mg/L. Patients between 1.0 and 5.9 years of age were significantly less likely to achieve an initial trough of 15 to 20 mg/L compared with other age groups evaluated (P=.041). Thirty-four patients with initial subtherapeutic troughs received a dose adjustment and a follow-up vancomycin trough. Of these patients, 15 (44.1%) achieved a trough between 15 and 20 mg/L. The median dose for patients achieving a therapeutic trough at any point during the study was 80 mg/kg per day.
A vancomycin dosing regimen of 15 mg/kg per dose every 6 hours is not likely to achieve a trough concentration of 15 to 20 mg/L in pediatric patients with complicated infections. An initial regimen of 80 mg/kg per day for these patients may be more likely to result in therapeutic steady-state concentrations of vancomycin.
确定每6小时一次、每次15mg/kg的万古霉素给药方案在患有复杂感染的儿科患者中达到15至20mg/L稳态谷浓度的发生率。
我们对2009年7月1日至2011年6月30日期间入住我院儿童医院的患者进行了回顾性病历审查。纳入标准为年龄在1个月至18岁之间，至少获得1次万古霉素稳态谷浓度，接受每6小时一次、每次15mg/kg的初始万古霉素剂量治疗，且正在接受脑膜炎、肺炎、骨髓炎、菌血症/败血症或心内膜炎诊断治疗的患者。
共纳入74例患者，平均年龄4.2±3.9岁，体重17.0±11.2kg。5例（6.8%）患者初始谷浓度为15至20mg/L。与其他评估年龄组相比，1.0至5.9岁的患者达到15至20mg/L初始谷浓度的可能性显著降低（P = 0.041）。34例初始谷浓度低于治疗水平的患者接受了剂量调整并进行了万古霉素谷浓度随访。在这些患者中，15例（44.1%）谷浓度达到15至20mg/L。在研究期间任何时间达到治疗性谷浓度的患者的中位剂量为每天80mg/kg。
每6小时一次、每次15mg/kg的万古霉素给药方案不太可能使患有复杂感染的儿科患者的谷浓度达到15至20mg/L。对于这些患者，初始方案为每天80mg/kg可能更有可能导致万古霉素达到治疗性稳态浓度。
