Wandstrat T L, Phleps S J
Neonatal Netw. 1994 Apr;13(3):33-9.
During the past decade, an increasing incidence of staphylococcus organisms resistant to penicillinase-resistant penicillins has necessitated the use of vancomycin. This increased utilization has revitalized research concerning efficacious vancomycin dosing regimens for premature neonates, infants, and children. Vancomycin dosing in neonates is variable because this patient population has decreased renal clearance and a larger volume of distribution than infants, children, or adults. The observation of the variability in vancomycin clearance and volume of distribution in infants with the same postconceptional age (PCA) but different gestational age (GA) suggests that the rates of maturation both extrauterine and intrauterine for disposition mechanisms of vancomycin are similar when PCAs are equal. Conditions such as patent ductus arteriosus, respiratory distress syndrome, sepsis, and asphyxia may further complicate the renal maturation process. Few investigations suggest vancomycin dosing regimens. Most of these studies propose dosing regimens based on retrospective analysis of vancomycin pharmacokinetics obtained from regimens based on physician discretion. To ensure efficacious and rational vancomycin dosing for premature neonates and infants, regimens should consider PCA as well as body weight.
