Evaluation of vancomycin dosing and corresponding drug concentrations in pediatric patients.

OBJECTIVE To describe the relationships between dosing strategy, age, and vancomycin trough concentrations in pediatric patients. METHODS This is a retrospective review of hospitalized pediatric patients between 2 months and 17 years of age treated with intravenous vancomycin from 2008 to 2011. The primary outcome was the number of patients achieving a target trough concentration of 10 to 20 μg/mL in each age group and dosing group. The secondary outcomes were the number of patients in each group to achieve a trough concentration of 15 to 20 μg/mL and the incidence of vancomycin-induced nephrotoxicity. RESULTS A total of 102 patients were included in the analysis. Forty-six of 159 evaluated troughs (28.9%) were within the target range of 10 to 20 μg/mL. Dose was found to have a statistically significant effect on the ability to achieve a trough within the target range (P = .01). Of the 159 trough concentrations evaluated, only 11 (6.9%) were within the range of 15 to 20 μg/mL. Nephrotoxicity occurred in 7 patients and was not associated with supratherapeutic trough concentration or dose. CONCLUSIONS The number of trough concentrations within the target range of 10 to 20 μg/mL was low, and younger patients often needed doses >60 mg/kg per day to achieve a trough concentration in this range. The dose of vancomycin was found to have a statistically significant effect on the ability to achieve a trough concentration within the target range.