학회명: 2022 ASHP Midyear Clinical Meeting & Exhibition

    기간: 2022.12.04 - 2022.12.08

    장소 : Mandalay Bay Convention Center, Las Vegas, NV, US

    발표자 : Min Jeong Kim, Hye ji Moon, Geun Mi Park, Joowon Chung, Hye Won Han

Department of Pharmacy, Asan Medical Center, Seoul, Korea

Purpose

In children, updated guidelines for vancomycin recommend using area under the concentration-time curve (AUC) with Bayesian method for therapeutic drug monitoring (TDM) because of the problem of collecting blood samples and the variability of pharmacokinetic change. However, studies of vancomycin pharmacokinetics (PK) in children are rare. We aimed to evaluate the appropriate dosage of vancomycin according to a child’s age based on AUC.

Methods

We retrospectively collected clinical basic characteristics, initial vancomycin dosage, dosing interval and blood concentration on an electronic medical record system at our university hospital. We collected data on children under the age of 18 from September 2020 to May 2021. We used PrecisePK ® software (Healthware Inc., San Diego, CA.) to analyze PK data, which includes volume of distribution, half-life, AUC24 and the appropriate dosage of vancomycin.

Results

In 272 children, 469 blood trough concentration (Ctrough ) samples were reported. The initial dosage of vancomycin was 44.1±12.5 mg/kg/day. The Ctrough was 8.1 ± 4.1 mg/L and only 17 (6.3%) patients obtained the Ctrough ≥15 mg/L, which is the indicated therapeutic concentration for Methicillin-resistant Staphylococcus aureus (MRSA) infection. Infants had the highest Ctrough of 9.0±4.3 mg/L and toddlers had the lowest at 7.1±4.3 mg/L. When MIC is assumed to be 1 mg/L, the AUC/MIC was 333.0 ± 97.2, and only 55 (20.2%) patients achieved the goal of 400 to 600, while 213 (78.3%) patients attained less than 400. AUC/MIC according to the age group was significantly different (323.3±88.2 in neonates, 350.8±95.8 in infants, 309.9±103.4 in toddlers, 337.5±95.1 in childhood, and 356.1±90.6 in adolescents). To achieve an AUC/MIC of 400, vancomycin in children should be administered at least 54.9±15.9 mg/kg/day. By the age group, the appropriate daily dose of vancomycin was 35.6±7.6 mg/kg in neonates, 56.5±13.3 mg/kg in infants, 62.8±14.3 mg/kg in toddlers, 60.0±13.2 mg/kg in childhood, and 49.5±14.9 mg/kg in adolescents.

Conclusion

Based on AUC/MIC 400–600, the appropriate dosage of vancomycin in children was at least 54.9±15.9 mg/kg/day. The appropriate dosage of vancomycin significantly differed according to the age of the children. Toddlers needed the highest dose, and neonates needed the lowest dose. The initial dose of vancomycin should be used differently considering the age of the child.