1392 Monitoring of Serum Vancomycin Levels in Icu Pediatric Patients

Abstract

Aims: To analyze the results from the clinical monitoring of serum vancomycin levels among ICU pediatric patients.

Methods: A retrospective drug utilization evaluation was performed for pediatric patients who received intravenous vancomycin from 1 October 2007 to 31 March 2010. Dosing regimen was 40 mg/kg of body weight. All patients who received vancomycin for more than 72 hours had at least once trough serum concentration documented and were included in the study. Trough levels were obtained on steady state, 30 minutes before administration. Vancomycin concentrations were measured by an immunoassay procedure.

Results: A total of 138 samples were collected from 30 patients, aged 3 months to 16 years. Mean trough concentration was 12.9mcg/ml (median: 10.9, range: 0.2 - 46.7). Trough levels were below minimum suggested level of 10mcg/ml in 60 cases (43.5%) and above the upper limit of 15mcg/ml in 42 cases (30.4%). Fourteen of 42 cases (33.3%) with high vancomycin levels were patients with known renal failure and/or under renal replacement, whereas renal failure was documented only in 7 cases (11.9%) with suboptimal levels. Only 26% of serum samples (36 of 138) were in the therapeutic range.

Conclusions: Our data suggest only a fourth of the patients had serum levels in therapeutic range and almost half of this population had serum levels below the normal range. The dosing schedule of 40mg/kg/day in children is unlikely to achieve the recommended pharmacodynamic target. Alternative dosing such as 60mg/kg/day or continuous infusion should be considered in order to optimize the therapeutic effect.

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