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

Abstract

BACKGROUND: Empiric vancomycin dosing regimens fail to achieve recommended target trough concentrations 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. METHOD(S): 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 treatment were included if they did not meet the exclusion criteria: post-menstrual age (PMA) <25 weeks, weight <500 grams, glycopeptide allergy, receiving extracorporeal membrane oxygenation, vancomycin use within the previous 72 hours and renal impairment. The Vanc App used a published population pharmacokinetic model to generate a dose based on the infant's PMA, weight, creatinine and target vancomycin concentration. RESULT(S): Overall, 40 infants were included; 40% female, median weight 2505 (range 700-4460) grams and median PMA 37.4 (range 25.7-49.0) weeks. The median vancomycin dose was 45 (range 24-79) mg/kg/day. All infants had trough vancomycin concentrations measured at steady-state (24-<48 hours) and 30 (75%) achieved target concentrations. Five infants had supratherapeutic (median 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(S): 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 with no vancomycin-related nephrotoxicity or infusion-related reactions.Copyright © 2023. Published by Elsevier Ltd.