Transcription of Vancomycin Dosing and Monitoring for Pediatric Patients
1 Vancomycin Dosing and Monitoring for Pediatric Patients Guidelines developed by UWHC Department of Pharmacy Author: Jill Strayer, PharmD, James Conway, MD. Reviewed by: Antimicrobial Subcommitee Approved by P&T Committee: August 2009. Next Scheduled Review Date: August 2011. A. Background/Indications Vancomycin is a glycopeptide antibiotic that has activity against gram positive organisms including methicillin resistant Staphylococcus aureus (MRSA), and some Enterococcus species. Historically, Vancomycin in Pediatric Patients has been dosed at 40mg/kg/day for empiric Because of an increase in MRSA infections in Pediatric Patients , increased minimum inhibitory concentrations (MIC) required for treatment of many organisms, antibiotic penetration issues, and unique metabolic differences between children and adults, it has been shown that higher doses of Vancomycin may be required in some Pediatric Patients who are at high risk of developing infections with MRSA include Patients with current or prior skin and soft tissue infections, musculoskeletal infections, Patients treated with frequent courses of antibiotics, and frequent hospitalizations.
2 Providers should refer to the full Antimicrobial Guidelines for more detail, see Antimicrobial Use Guidelines B. Dosing and Adjustments Dosing recommendations for Patients with normal renal function: Use actual body weight for Dosing with a maximum of 2 grams/dose. Age empiric dosing1 High suspicion for CNS. infections, MRSA, osteomyelitis or Oncology/BMT patients1,2,3. Age <1 month Refer to Neofax or Pediatric Refer to Neofax or Pediatric Pharmacist (pager 7589) Pharmacist (pager 7589). 1 month 6 years 40mg/kg/day divided every 6 hours 60mg/kg/day divided every 6 hours > 6 years 18 years 40mg/kg/day divided every 8 hours 60mg/kg/day divided every 6 hours > 18 years 15mg/kg/dose every 12 hours 15mg/kg/dose every 8 hours *May also consider higher Dosing for Patients in Pediatric Intensive Care Pediatric Creatinine Clearance1. Schwartz equation: CrCL (ml/minute) = K x length in cm SCr Age K. Low birth weight 1 year Full term 1 year > 1 year 12 years 13-21 years Female 13-21 years Male Dosing Adjustments Suggestions in Renal Failure1.
3 CrCl Frequency > 90 ml/minute Every 6 hours 70-89 ml/minute Every 8 hours 46-69 ml/minute Every 12 hours 30-45 ml/minute Every 18 hours 15-29 ml/minute Every 24 hours <15 ml/minute or Based on Vancomycin trough Hemodialysis levels C. Target concentrations All Pediatric Patients will receive Vancomycin levels at the discretion of the Pediatric pharmacist (per Inpatient Serum Drug Concentration Monitoring policy) or medical team. Vancomycin troughs are recommended to be drawn within 1 hour prior to next dose. Vancomycin peak levels are not routinely recommended because of lack of correlation to efficacy. In general, a trough concentration of 10-15 mcg/mL is desired. Trough concentrations of 15 - 20mcg/mL are recommended for patient with CNS infections, osteomyelitis, hospital acquired infections and suspected For MRSA isolates with an MIC of 1mg/L, achieving levels of 15-20 mcg/mL. also allows for AUC/MIC ratio >400. Clinical pharmacists will assess levels and make recommendations to the medical team for each level drawn.
4 The maximum recommended dose for adult or Pediatric Patients is 100mg/kg/day or 6 grams/day. Patients should have Vancomycin troughs and serum creatinine drawn on a weekly basis while on therapy. References 1. Pediatric Dosage Handbook, 15th Edition, 2008. 2. Frymoyer A et al. Current Recommended Dosing of Vancomycin for Children With Invasive Methicillin-Resistant Staphylococcus aureus Infections is Inadequate. Ped Infect Dis J 2009; 28(5):398-402. 3. Piro C et al. Initial Vancomycin Dosing in Pediatric Oncology and Stem Cell Transplant Patients . J Pediatr Hematol Oncol 2009; 31(1): 3-7. 4. Glover ML et al. Vancomycin Dosage Requirements Among Pediatric Intensive Care Unit Patients With Normal Renal Function. J Crit Care 2000; 15(1): 1-4. 5. Rybak M et al. Therapeutic Monitoring of Vancomycin in Adult Patients : A Consensus Review of the American Society of Health-System Pharmacists, the Infectious Disease Society of America, and the Society of Infectious Disease Pharmacists.
5 Am J Health- Syst PHarm 2009; 66(1): 82-98.
