Vancomycin Dosing and Monitoring for Pediatric Patients

[Pages:2]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 treatment.1 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.2 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.

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 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 Unit.4

Pediatric Creatinine Clearance1 Schwartz equation: CrCL (ml/minute) = K x length in cm

SCr

Age

K

Low birth weight 1 year

0.33

Full term 1 year

0.45

> 1 year ? 12 years

0.55

13-21 years Female

0.55

13-21 years Male

0.7

Dosing Adjustments Suggestions in Renal Failure1 CrCl

> 90 ml/minute 70-89 ml/minute

Frequency Every 6 hours Every 8 hours

46-69 ml/minute 30-45 ml/minute 15-29 ml/minute 400. Clinical pharmacists will assess levels and make recommendations to the medical team for each level drawn. 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. Am J HealthSyst PHarm 2009; 66(1): 82-98.

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