Kenneally Allison M, Leonhardt Kelsey R, Schadler Aric, Garlitz Karen L
Department of Pharmacy (AMK, KRL, KLG), University of Kentucky Healthcare, Lexington, KY.
Department of Pediatrics (AS), Kentucky Children's Hospital, Lexington, KY.
J Pediatr Pharmacol Ther. 2023;28(4):335-342. doi: 10.5863/1551-6776-28.4.335. Epub 2023 Aug 9.
Review the efficacy and safety of an updated empiric vancomycin dosing protocol in a neonatal intensive care unit (NICU).
Retrospective chart review including neonates with postmenstrual age (PMA) less than 40 weeks without renal dysfunction who received vancomycin per protocol at a single institution's NICU before and after implementation of an updated dosing protocol. The primary outcome is the proportion of initial therapeutic troughs. Secondary outcomes include average trough, achievement of a therapeutic trough, number of days before attainment of a therapeutic trough, and proportion of acute kidney injury (AKI) during therapy.
The 2 groups were similar in gestational age, race, birth weight, PMA, and weight at time of vancomycin initiation. The post-implementation group had a higher proportion of initial therapeutic troughs (33.0% vs 55.1%) and a lower proportion of a subtherapeutic (58.7% vs 43.8%) and supratherapeutic (8.3% vs 1.1%) initial troughs (p = 0.002). The median trough was not different (9.20 vs 10.50 mg/L; p = 0.092). There was no difference in the proportions of achieving a therapeutic trough throughout therapy (69% vs 76%; p = 0.235); however, the post-implementation group achieved a therapeutic trough 1 day earlier (3 vs 2 days; p < 0.001). There was no difference in proportions of AKI developing between the pre-implementation vs post-implementation groups (10.1% vs 5.6%; p = 0.251).
Implementation of an updated vancomycin dosing protocol yielded a higher percentage of initial therapeutic vancomycin troughs and patients reached the therapeutic range 1 day earlier without increasing the proportion of AKI.
回顾新生儿重症监护病房（NICU）中更新后的经验性万古霉素给药方案的疗效和安全性。
进行回顾性病历审查，纳入在单一机构的NICU中，在更新后的给药方案实施前后，按照方案接受万古霉素治疗的、月经龄（PMA）小于40周且无肾功能障碍的新生儿。主要结局是初始治疗谷浓度的比例。次要结局包括平均谷浓度、达到治疗谷浓度的情况、达到治疗谷浓度前的天数以及治疗期间急性肾损伤（AKI）的比例。
两组在胎龄、种族、出生体重、PMA以及开始使用万古霉素时的体重方面相似。实施后组初始治疗谷浓度的比例更高（33.0%对55.1%），亚治疗性（58.7%对43.8%）和超治疗性（8.3%对1.1%）初始谷浓度的比例更低（p = 0.002）。中位谷浓度无差异（9.20对10.50 mg/L；p = 0.092）。整个治疗过程中达到治疗谷浓度的比例无差异（69%对76%；p = 0.235）；然而，实施后组达到治疗谷浓度提前了1天（3天对2天；p < 0.001）。实施前组与实施后组之间发生AKI的比例无差异（10.1%对5.6%；p = 0.251）。
更新后的万古霉素给药方案的实施使初始治疗性万古霉素谷浓度的百分比更高，患者提前1天达到治疗范围，且未增加AKI的比例。
