Individualized vancomycin dosing in infants: prospective evaluation of an online dose calculator

被引：2

作者：

Wilkins, Amanda L. ^{[1
,2
,3
,26
]}

Lai, Tony ^{[4
,5
]}

Zhu, Xiao ^{[6
]}

Bolisetty, Srinivas ^{[7
]}

Chiletti, Roberto ^{[8
,9
,10
]}

Cranswick, Noel ^{[1
,2
,11
,12
]}

Gardiner, Kaya ^{[3
,13
]}

Hunt, Rodney ^{[14
,15
,16
]}

Malhotra, Atul ^{[14
,15
]}

McMullan, Brendan ^{[17
,18
]}

Mehta, Bhavesh ^{[19
,20
]}

Michalowski, Joanna ^{[7
]}

Popat, Himanshu ^{[19
,21
,22
]}

Ward, Meredith ^{[7
,23
]}

Duffull, Stephen ^{[24
]}

Curtis, Nigel ^{[2
,3
,25
]}

Gwee, Amanda ^{[2
,3
,25
]}

机构：

[1] Royal Childrens Hosp Melbourne, Dept Gen Med, Parkville, Vic, Australia

[2] Univ Melbourne, Dept Paediat, Parkville, Vic, Australia

[3] Murdoch Childrens Res Inst, Infect Dis Grp, Parkville, Vic, Australia

[4] Childrens Hosp Westmead, Pharm Dept, Westmead, NSW, Australia

[5] Univ Sydney, Sch Pharm, Camperdown, NSW, Australia

[6] Fudan Univ, Sch Pharm, Dept Clin Pharm & Pharm Adm, Shanghai, Peoples R China

[7] Royal Hosp Women, Dept Newborn Care, Randwick, NSW, Australia

[8] Royal Childrens Hosp Melbourne, Dept Intens Care, Parkville, Vic, Australia

[9] Murdoch Childrens Res Inst, Paediat Intens Care Res Grp, Melbourne, Vic, Australia

[10] Univ Melbourne, Dept Crit Care, Melbourne, Vic, Australia

[11] Royal Childrens Hosp Melbourne, Clin Pharmacol Unit, Parkville, Vic, Australia

[12] Murdoch Childrens Res Inst, Melbourne Childrens Trials Ctr, Parkville, Vic, Australia

[13] Royal Childrens Hosp Melbourne, Res Operat, Parkville, Vic, Australia

[14] Monash Childrens Hosp, Monash Newborn, Clayton, Vic, Australia

[15] Monash Univ, Dept Paediat, Clayton, Vic, Australia

[16] Murdoch Childrens Res Inst, Clin Sci Theme, Parkville, Vic, Australia

[17] Univ New South Wales, Fac Med, Sydney, NSW, Australia

[18] Sydney Childrens Hosp, Dept Immunol & Infect Dis, Randwick, NSW, Australia

[19] Childrens Hosp Westmead, Grace Ctr Newborn Intens Care, Westmead, NSW, Australia

[20] Univ Sydney, Sydney Med Sch, Discipline Paediat & Child Hlth, Sydney, NSW, Australia

[21] NHMRC Clin Trial Ctr, Camperdown, NSW, Australia

[22] Univ Sydney, Sydney Childrens Hosp, Westmead Clin Sch, Camperdown, NSW, Australia

[23] Univ New South Wales, Sch Womens & Childrens Hlth, Randwick, NSW, Australia

[24] Univ Otago, Sch Pharm, Dunedin, New Zealand

[25] Royal Childrens Hosp Melbourne, Dept Infect Dis, Parkville, Vic, Australia

[26] Univ Melbourne, Royal Childrens Hosp Melbourne, Dept Paediat, 50 Flemington Rd, Parkville, Vic 3052, Australia

来源：

INTERNATIONAL JOURNAL OF ANTIMICROBIAL AGENTS | 2023年 / 61卷 / 03期

基金：

澳大利亚国家健康与医学研究理事会;

关键词：

vancomycin; individualized dosing; pharmacokinetics; infants; neonates; INFECTIOUS-DISEASES SOCIETY; HEALTH-SYSTEM PHARMACISTS; AMERICAN SOCIETY;

D O I：

10.1016/j.ijantimicag.2023.106728

中图分类号：

R51 [传染病];

学科分类号：

100401 ;

摘要：

Background: Empiric vancomycin dosing regimens fail to achieve recommended target trough concentra-tions of 10-20 mg/L in the majority of infants. This study assessed the performance of a model-based dosing calculator (Vanc App) in achieving target vancomycin concentrations at first steady-state level.Methods: This was a multicenter prospective study in four tertiary pediatric hospitals over an 18-month period. Infants aged 0-90 days with suspected Gram-positive sepsis requiring empiric vancomycin treat-ment were included if they did not meet any of the exclusion criteria: post-menstrual age (PMA) < 25 weeks, weight < 500 g, glycopeptide allergy, receiving extracorporeal membrane oxygenation, vancomycin use within the previous 72 h, and renal impairment. The Vanc App used a published population pharma-cokinetic model to generate a dose based on the infant's PMA, weight, creatinine, and target vancomycin concentration.Results: A total of 40 infants were included; 40% were female, median (range) weight was 2505 (700-4460) g and median (range) PMA was 37.4 (25.7-49.0) weeks. The median (range) vancomycin dose was 45 (24-79) mg/kg/day. All infants had trough vancomycin concentrations measured at steady-state (24-< 48 hours) and 30 (75%) infants achieved target concentrations. Five infants had supratherapeutic (me-dian 25, range 21-38 mg/L) and five had subtherapeutic (median 6, range < 5-9 mg/L) concentrations. An area under the concentration-time curve (AUC0-24) of 400-650 mg/L.h was achieved in 33 (83%) infants. There were no infusion-related reactions or nephrotoxicity.Conclusion: Individualized intermittent vancomycin dosing using a model-based online calculator resulted in 75% and 83% of infants achieving target trough and AUC0-24, respectively, at first steady-state level.There were no vancomycin-related nephrotoxicity or infusion-related reactions.(c) 2023 Elsevier Ltd and International Society of Antimicrobial Chemotherapy. All rights reserved.

引用

页数：7

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